Arola M K, Puhakka H, Mäkelä P
Acta Anaesthesiol Scand. 1980 Jun;24(3):169-77. doi: 10.1111/j.1399-6576.1980.tb01528.x.
The healing of tracheostomy and cuff-induced tracheal injury was followed up in 48 tracheostomized patients (44 men and 4 women). The patients were studied by means of tracheoscopy, fluoroscopy and tracheography, with a positive contrast medium. At extubation, tracheoscopy revealed 12 mild, 23 moderate and 13 severe injuries at the cuff level. Three months after extubation, the stoma had closed in 89% of the patients studied. In 85% of the patients, the side wall of the stoma was found to have collapsed inwards and in 71% scars were observed at the cuff level. No significant changes took place after the follow-up study at 3 months. At tracheography it was found that narrowing of the tracheal diameter at the stomal level was of only mild or moderate degree (i.e. 0-33%). There was not a single instance of severe stenosis. At the cuff level, a slight inward collapse of the side wall was observed in one patient, and in all the other patients the lumen was normal. Fluoroscopy did not reveal severe tracheomalacia in any patient. Increased mobility of the stomal scar, especially in connection with coughing was seen in some patients. One tracheo-innominate artery erosion and one bleeding granulation tissue at the stoma were confirmed during follow-up. Surgical trauma to the trachea at the stoma seems to be a more potent cause of subsequent narrowing of the trachea than the cuff. Even though severe injuries may also heal with few sequelae, the use of tracheostomy tubes with large, low-pressure cuffs, which have been shown to cause less damage to the trachea, is indicated.
对48例接受气管造口术的患者（44例男性和4例女性）进行了气管造口及套管所致气管损伤愈合情况的随访。通过气管镜检查、荧光透视检查和气管造影术，使用阳性造影剂对患者进行研究。拔管时，气管镜检查显示在套管水平有12例轻度损伤、23例中度损伤和13例重度损伤。拔管后3个月，89%的研究患者造口已闭合。在85%的患者中，发现造口侧壁向内塌陷，71%的患者在套管水平观察到瘢痕。3个月的随访研究后未发生显著变化。气管造影发现，造口水平气管直径变窄仅为轻度或中度（即0 - 33%）。没有一例严重狭窄。在套管水平，仅1例患者观察到侧壁轻微向内塌陷，其他所有患者管腔均正常。荧光透视检查未发现任何患者有严重气管软化。在一些患者中可见造口瘢痕活动度增加，尤其是与咳嗽相关时。随访期间证实有1例气管无名动脉侵蚀和1例造口处出血性肉芽组织。造口处气管的手术创伤似乎比套管更易导致随后的气管狭窄。尽管重度损伤也可能愈合且后遗症较少，但仍建议使用已证明对气管损伤较小的大尺寸、低压套管的气管造口管。
