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目的 :探讨小儿气管切开拔管困难的原因 ,提高拔管成功率。方法 :对 6 9例气管切开后拔管困难患儿的临床资料进行回顾性分析。结果 :经过喉镜、支气管镜及X线检查发现造成小儿气管切开拔管困难的因素是 :原发病短期内不能治愈 4 2例 (6 0 .9% ) ,拔管方法不当 14例 (2 0 .3% ) ,气管切开位置偏高 4例 (5 .8% ) ,气管狭窄 4例 (5 .8% ) ,呼吸道分泌物堵塞 5例 (7.2 % )。对症处理后 ,4 9例拔管成功 ,18例未能除管 ,2例戴管期间因脱管死亡 ,拔管者有 15例形成气管皮肤瘘。 <1岁者拔管率为 91.3% ,≥ 1岁者为 6 2 .2 %。结论 :原发病未治愈是小儿气管切开拔管困难的主要原因 ,其次是拔管方法不当 (包括堵管方法及拔管时机 ) ,与气管切开有关的因素是气管切开位置偏高和气管切口处狭窄。拔管困难与小儿年龄大小无关。
Objective: To investigate the causes of pediatric tracheotomy extubation difficulties and improve the success rate of extubation. Methods: The clinical data of 69 children with extubation after tracheotomy were retrospectively analyzed. Results: After laryngoscopy, bronchoscopy and X-ray examination found that pediatric tracheotomy extubation difficult factors are: the primary disease can not be cured in 42 cases (60.9%), improper extubation in 14 cases ( 4 cases (5. 8%) had tracheotomy, 4 cases (5.6%) had tracheal stricture, and 5 cases (7.2%) had respiratory secretions blocked. Symptomatic treatment, 49 cases of successful extubation, 18 cases failed to remove the tube, 2 cases of death due to detubulation during catheterization, extubation 15 cases of tracheal fistula formation. The extubation rate of <1 year old was 91.3%, and that of ≥ 1 year old was 62.2%. Conclusion: The primary disease is not cured is the main reason for pediatric tracheotomy extubation is difficult, followed by improper extubation (including the method of plugging and extubation timing), and tracheotomy-related factors tracheostomy position is too high And tracheal incision stenosis. Difficult extubation and age of children has nothing to do.