摘要
背景：氣管造口術（氣切）為常進行的手術之一。隨著時代的改變及醫療的進步，包括病患特徵、氣切方式及併發症發生的情形，在20世紀末至21世紀有很大的改變。本研究收集備有完整住院病歷資料之接受氣切病患65例，進行分析討論。 方法：採病歷回溯方式，整理自2001年1月至2003年12月由本科進行氣切病患之病歷，分析氣切病患特徵、氣切方式、氣切適應症、術後併發症及術後追蹤情形。 結果：共65例列入研究，其中性別為男性者35名，女性30名。年齡從41歲到96歲，平均年齡71歲。氣切適應症以長期插管最常見。在加護病房或一般病房病床邊(bedside)進行手術有52例，在開刀房有12例，在急診室有1例。手術採局部麻醉有61例，全身麻醉有4例。手術方式：在環狀軟骨與胸骨凹口間的皮膚做約4cm中線垂直切開，在第2或第3氣管軟骨環做橢圓形切除。沒有病患在手術中死亡或發生併發症，少數患者有術後出血及感染問題，有兩位患者發生術後氣切套管阻塞，其中1名在氣切口周圍有嚴重的肉芽組織。平均術後追蹤時間約6個月，有5名病患順利移除氣切套管。 結論：本研究顯示接受氣切的病患以老年族群為主，適應症以長期插管居多。我們認為在有術前氣管內插管的前提下，大多數的病患可在加護病房或一般病房病床邊，採用局部麻醉進行氣切。
並列摘要
BACKGROUND: Tracheostomy is one of the most common surgical procedures in medical profession. With the improvement of equipments and medical care, there have been great changes in patient characteristics, surgical technique and complications. In this paper, we analyzed 65 patients who received tracheostomy at our hospital. METHODS: A retrospective study of patients undergoing tracheostomy during January 2001 and December 2003 is presented. We analyzed the patient's characteristics, surgical technique, indications for this procedure, the major complications of tracheostomy and postoperative follow-up. RESULTS: Sixty-five patients were included in this research. Out of the 65 patients, 35 of them were male and 30 were female, aged between 41 and 96 years old. The average age was 71. The most common indication for tracheostomy was prolonged intubation. Fifty-two patients received tracheostomy bedside in the intensive care unit or in the general ward, 12 in the operation rooms and 1 in the emergency room. Sixty-one procedures were performed under local anesthesia and 4 procedures under general anesthesia. The procedure included a 4 cm vertical midline skin incision between cricoid cartilage and sternal notch, an elliptical cut incision on the 2nd or 3rd tracheal rings. No mortalities or major complications occurred during the procedures. A few patients suffered from post-operative wound bleeding and infection. Two patients suffered from obstruction of tracheostomy tube and one of them had severe peristomal granulation. The average follow-up period was approximately 6 months. Five patients were weaned successfully. CONCLUSION: This research showed that most of patients with tracheostomy were the elderly. Prolonged intubation accounted for the most common indication for tracheostomy. We considered that most of tracheostomies can be done safely bedside in the ICU or in the general ward under local anesthesia.