氣管切開術之併發症－多中心回溯研究

Complications of Tracheostomy-A Multi-Center Retrospective Study

王大昆(Da-Kun Wang) ； 王拔群(Pa-Chun Wang) ； 張燕良(Yen-Liang Chang) ； 黃鈞鴻(Chun-Hung Huang) ； 李國森(Kuo-Sheng Lee) ； 蔡銘修(Ming-Hsui Tsai) ； 花俊宏(Chun-Hung Hua) ； 方深毅(Sheen-Yie Fang) ； 羅宏一(Hung-I Lo) ； 陳培榕(Peir-Rong Chen) ； 林正明(Zeng-M)

《台灣耳鼻喉頭頸外科雜誌》 41卷1期 (2006/02) Pp. 19-29

https://doi.org/10.6286/2006.41.1.19

摘要

OBJECTIVE: The aims of this project are to analyze the complications and risk factors of tracheostomy.
MATERIALS AND METHODS: This study was conducted in a retrospective manner. Medical records from patients who had received tracheostomy in 5 medical centers during 2002-4 were randomly sampled and reviewed. Prevalence of complications was identified and the causes of adverse outcomes were analyzed.
RESULTS: A total of 969 procedures are identified. The mean age of patients is 57 years old. There are 873 adults and 96 children. The gender ratio is 2.7:1 (male: female). In general, complication occurred in 87 (9%) patients. Direct tracheostomy-related mortality is 0.9% (9 patients). The most frequent complications are: hemorrhage (19, 2.0%), stomal granulation (19, 2.0%), infection (15, 1.5%), subcutaneous emphysema (11, 1.1%) and tracheal stenosis (10, 1.0%). The general complication rates are higher in pediatric (20.8% vs. 7.7%, p＜0.01), ENT (12.6% vs. 4.9 % of non-ENT, p＜0.01), coagulopathy (31.7% vs.7.9%, p＜0.01), with anti-coagulant therapy (37.5% vs. 8.5%, p＜0.01) patients, high ASA Class (Ⅴ＞Ⅳ＞Ⅲ＞Ⅰ＞Ⅱ, 25%＞14%＞8.7%＞8.6%＞4.3%, p=0.001), alert conscious (alert 11.3%＞coma 9.6%＞stupor 5.9%＞lethargy 5.6%＞obtunding 2.5%, p=0.021), upper airway obstruction (upper airway obstruction 24.7% ＞ thers 20.8%＞prolonged intubation 7.9%＞airway care or security 7.8% ＞ head and neck surgery 4.7%, p＜0.001), difficult condition for tracheostomy (27.4% vs 8%, p＜0.001) and using neck straps as tube fixation method (10.3% vs 5.6%, p＜0.001). We find that child, patient’s coagulation problem, post-tracheostomy ventilator use, thyroid isthmus management, presence of difficult condition for tracheostomy and using neck straps as tube fixation method are risk factors for tracheostomy complications.
CONCLUSION: Tracheostomy is a highly morbid procedure because it is often performed on patients with multiple systemic problems or with critical airway conditions. It is worthwhile to take quality improvement measures into account for the enhancement of tracheostomy safety.

關鍵字

氣管切開術 ； 併發症 ； 危險因子

並列摘要

OBJECTIVE: The aims of this project are to analyze the complications and risk factors of tracheostomy.
MATERIALS AND METHODS: This study was conducted in a retrospective manner. Medical records from patients who had received tracheostomy in 5 medical centers during 2002-4 were randomly sampled and reviewed. Prevalence of complications was identified and the causes of adverse outcomes were analyzed.
RESULTS: A total of 969 procedures are identified. The mean age of patients is 57 years old. There are 873 adults and 96 children. The gender ratio is 2.7:1 (male: female). In general, complication occurred in 87 (9%) patients. Direct tracheostomy-related mortality is 0.9% (9 patients). The most frequent complications are: hemorrhage (19, 2.0%), stomal granulation (19, 2.0%), infection (15, 1.5%), subcutaneous emphysema (11, 1.1%) and tracheal stenosis (10, 1.0%). The general complication rates are higher in pediatric (20.8% vs. 7.7%, p＜0.01), ENT (12.6% vs. 4.9 % of non-ENT, p＜0.01), coagulopathy (31.7% vs.7.9%, p＜0.01), with anti-coagulant therapy (37.5% vs. 8.5%, p＜0.01) patients, high ASA Class (Ⅴ＞Ⅳ＞Ⅲ＞Ⅰ＞Ⅱ, 25%＞14%＞8.7%＞8.6%＞4.3%, p=0.001), alert conscious (alert 11.3%＞coma 9.6%＞stupor 5.9%＞lethargy 5.6%＞obtunding 2.5%, p=0.021), upper airway obstruction (upper airway obstruction 24.7% ＞ thers 20.8%＞prolonged intubation 7.9%＞airway care or security 7.8% ＞ head and neck surgery 4.7%, p＜0.001), difficult condition for tracheostomy (27.4% vs 8%, p＜0.001) and using neck straps as tube fixation method (10.3% vs 5.6%, p＜0.001). We find that child, patient’s coagulation problem, post-tracheostomy ventilator use, thyroid isthmus management, presence of difficult condition for tracheostomy and using neck straps as tube fixation method are risk factors for tracheostomy complications.
CONCLUSION: Tracheostomy is a highly morbid procedure because it is often performed on patients with multiple systemic problems or with critical airway conditions. It is worthwhile to take quality improvement measures into account for the enhancement of tracheostomy safety.

並列關鍵字

tracheostomy ； complication ； risk factor