耳鼻咽喉科学课件：5_3气管切开术.ppt

气管切开术 概 念 一种抢救危重病人的急救手术，系将气管前壁切开，插入合适套管，解除呼吸道阻塞。 应用解剖 颈段气管7-8环 前为皮肤、颈白线 后为食管前壁 颈前安全三角 切开位置：颈段气管3-4环 适应症 手术方法 患者仰卧位，肩下垫肩，头部后仰 颈段气管变浅，向上暴露 放入气管导管 术后护理 保持套管通畅 维持下呼吸道通畅 室内保持适宜的温度和湿度 保持颈部切口清洁 防止套管阻塞或脱出 拔管 并发症 皮下气肿：分离太多、缝合过紧、剧烈咳嗽 纵隔气肿：剥离气管前筋膜过多 气胸：胸膜顶受损 出血：原发性、继发性 气管食管瘘 拔管困难 环状软骨受损 呼吸困难之病因未解除 软骨坏死、肉芽生长 * * Antonio Musa Brasavola, an Italian physician, performed the first documented case of a successful tracheotomy. He published his account in 1546. The patient, who suffered from a laryngeal abscess and recovered from the procedure INDICATIONS FOR TRACHEOTOMY Current indications for tracheotomy are: prolonged intubation and mechanical ventilation, bypass of an upper airway obstruction, easier management of secretions, as an adjunct to chest or head and neck surgery in which ventilation problems or prolonged intubation are anticipated ( Table 106-2 ). The earliest indication for the procedure was upper airway obstruction resulting from trauma or infection. As late as the 1950s, the major indication for 2444 Other causes of upper airway obstruction necessitating tracheotomy include obstruction due to neoplastic processes, or functional obstruction such as bilateral vocal cord paralysis or edema secondary to smoke inhalation or caustic agent ingestion. In such cases, patients are usually stabilized by tracheal intubation or with a cricothyrotomy and tracheotomy later. Although facial fractures in and of them selves are not an indication for tracheotomy, in cases of severe maxillo-facial trauma, tracheotomy is sometimes used to secure an airway where intubation would be difficult or damaging. Today, the most common indication for tracheotomy is prolonged tracheal intubation, usually with mechanical ventilation. A recent review of more than 1000 consecutive tracheotomies found that 76% were performed to facilitate mechanical ventilation.[21 There is no evidence to guide the frequency of tracheostomy tube changes. It is a common