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目的总结气管切开对脑卒中患者的抢救治疗意义、适应证、手术特点及并发症。方法回顾性分析110例行紧急气管切开术脑卒中患者的资料。结果110例患者中合并严重颈椎病采用平卧位手术者5例。术中出现呼吸暂停而先行气管插管再行气管切开者6例。抗凝治疗凝血功能下降术中使用双极电凝止血8例,合并肺气肿肺尖上移4例,置管时出现长时间屏气血氧饱和度一过性严重下降者6例。出现并发症16例(14.5%),其中因术后伤口渗血行油纱条局部压迫止血者5例,二次手术止血3例,皮下气肿5例,脱管3例,气管内套管阻塞1例。94例患者好转拔管,13例带管回家,3例死于原发病。结论气管切开术对脑卒中患者抢救生命、减少并发症及促进早日康复有重要意义,手术有一定的特点,应采取相应的灵活处理方法。
Objective To summarize the significance of tracheotomy in stroke patients, indications, surgical features and complications. Methods A retrospective analysis of 110 cases of emergency tracheotomy patients with stroke data. Results 110 cases of patients with severe cervical spondylosis by supine surgery in 5 cases. Intraoperative apnea and tracheal intubation first tracheotomy in 6 cases. Anticoagulant treatment of coagulation decreased surgery bipolar coagulation hemostasis in 8 cases, pulmonary edema merged in 4 cases, when the tube for a long time when the breath-hold oxygen saturation in a serious decline in 6 cases. Complications occurred in 16 cases (14.5%), of which 5 cases of hemostasis caused by partial pressure of oil gauze due to postoperative wound bleeding, 3 cases of secondary hemostasis, 5 cases of subcutaneous emphysema, 3 cases of detuning and endotracheal tube occlusion 1 case. 94 patients improved extubation, 13 patients with duct home, 3 died of primary disease. Conclusions Tracheotomy is of great importance to save lives, reduce complications and promote early recovery in patients with stroke. Surgery has certain characteristics and should be treated flexibly.