小兒氣管切開術之臨床分析

Clinical Analysis of Pediatric Tracheotomy

黃志銘(Chi-Ming Hwan) ； 李國森(Kuo-Sheng Lee) ； 楊政謙(Cheng-Chien Yung) ； 林書賢(Su-Hsien Lin) ； 張克昌(Ke-Chang Chang)

《中華民國耳鼻喉科醫學雜誌》 34卷6期 (1999/11) Pp. 448-455

https://doi.org/10.6286/1999.34.6.448

摘要

背景：小兒氣管切開術為一救命的手術，其併發症及死亡率均較成人為高。本文乃提出本科對小兒氣管切開術的手術經驗及臨床分析。
方法：本科自1991年12至1999年2月，收集57例接受小兒氣管切開術的病例。就其性別、年齡、插管時間、病因、併發症及手術預後等進行分析並加以討論。
結果：57例中，男性29例(50.9%)，女性28例(49.1%)。平均年齡11.5個月(若扣除一12歲及一14歲之病例，平均年齡則降為5.88個月)。其中小於1歲者佔48例(84.2%)。其平均插管時間為35.2天。病因中有17例為雙側聲帶麻痺(29.4%)，12例為聲門下狹窄(20.7%)。57例中有11例成功拔管(19.3%)，平均從進行氣管切開術至成功拔管的時間為561天。有11例(19.3%)出現併發病，其中以痰阻塞氣切管最多。有12例死亡(21.1%)，其中以肺炎引起敗血症及痰阻塞氣切管最常見。
結論：小兒氣管切開其技術較成人氣管切開術為難，護理照顧上亦較成人複雜，且其死亡率及併發症亦較成人為高。故需仔細評估小兒氣管切開術之適應症，術前可以纖維內視鏡或通氣式支氣管鏡加以評估，術後亦可藉其評估拔管之時間。(中耳醫誌 1999;34:448-455)

關鍵字

氣管切開術 ； 小兒

並列摘要

BACKGROUD: Tracheostomy has been known in pediatrics as a life-saving surgical procedure with significant morbidity and mortality. The complication rates are also greater in children than in adults. The purpose of this article is to present our experience with pediatric tracheostomy.
METHOD: We reviewed the crcord of 57 pediatric patients who had tracheostomy performed from December, 1991 to February, 1999 at Mackay Memorial Hospital. Their sexes, ages, intubation periods, underlying diseases, complications, and duration of cannulation were recorded.
RESULTS: There were 29 boys (50.9%) and 28 girls (49.1%). The ventilation bronchoscopy or fibrobronchoscopy were used for evaluation of fairway condition preoperatively. The mean age at tracheostomy was 11.5 months (IF we excluded two patients who were 12 and 14 years old, the mean age was 5.88 months). Indications for surgery were bilateral vocal cord paralysis – 17 cases (29.4), subglottic senosis – 12 cases (20.7%) and others. At the end of the study, 11 patients were successfully decannulated after a mean duration of 18 months. Complicaations related to the tracheostomy occurred in 11 patients (19.3%) and tube obstruction was the most common cause. Twelve patients died (21.1%) during the cannulation period. Sepsis caused by pneumonia and tube obstruction were the most common causes of death.
CONCLUSION: The surgical techniques for tracheostomy in peditatric patients are more difficult with significantly higher mortality and complication rates than in adults. Pre-operative and post-operative airway evaluation with ventilation bronchoscopy or flexible fiberoptic endoscopy are important.

並列關鍵字

tracheotomy ； pediatrics