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气管切开术概述

Author
Robert C Hyzy, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
范红, 教授

引言

气管插管或气管切开插管都可为机械通气提供气流通路。在急性呼吸衰竭发作期间，患者一般通过气管插管进行通气。但预计机械通气的时间需延长时，经常考虑改为气管切开插管。气管切开术有关临床问题的概述将在此讨论。关于气管插管和长期通气的一般问题参见其他专题。 (参见“气管内导管的管理和并发症”和“重症监护病房中成人患者脱机困难的管理”和“长期机械通气患者的管理及预后”)

气管切开术 vs 气管插管

气管切开术和气管插管的相对优点和缺点见链接表中的总结(表 1)。

呼吸功 — 来自小型研究的数据表明，对于机械通气和自主呼吸的患者，在气管切开术后，其呼吸功、压力-时间的乘积、气道阻力、吸气峰压、内源性呼气末正压(positive end-expiratory pressure, PEEP)(内源性PEEP也称自动PEEP)都下降[1-4]。此外，呼吸器的同步和触发可能增强，但潮气量、呼吸频率和死腔样通气保持不变[1,5]。这些变化–连同其他变量(如呼吸道的分泌物、对分泌物的清除及患者的舒适度)–可能有助于机械通气的撤机。

误吸 — 气管切开和气管插管均常见口咽部内容物的误吸。这是气道套囊上方咽部积聚分泌物和吞咽反射触发延迟共同导致的结果[6,7]。  误吸的风险与口咽部分泌物的量直接相关。

电视透视检查未能证实即将拔管前的吞咽力学发生改变[8]。然而，在气管切开的患者中，误吸的发生率为30%-50%，在75%-82%的病例中，误吸没有临床症状[9-11]。为能发声而用一个封管帽或手指闭塞气管切口，不会显著增加误吸的发生率[11]。当气管切开已持续3周时，误吸的可能性可能在某种程度上下降[10]。

              

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Literature review current through: 2017-07 . | This topic last updated: 2016-10-13.
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