气管切开术在重症患儿中的临床应用进展

Tracheotomy in Critically Ill Children: Clinical Applications and Advances

摘要: 随着医学发展，儿童气管切开术适应症发生了显著变化，长时间机械通气患儿成为行气管切开术的主要人群。气管切开术也逐渐成为儿童重症监护病房常见的干预方式之一，但在儿童患儿中行气管切开的时机尚无明确共识。目前国内外研究就儿童气切时机选择大多倾向于早期气切，早期气切将会缩短ICU住院时长、总住院时长、机械通气时长、镇静剂使用时间，但对死亡率、呼吸机相关肺炎发生率却影响不一。但具体气切时机的选择需结合患者病情情况和基础疾病。本文重点旨在对气管切开术的发展、指征、气管切开术方式及优缺点，护理及常见并发症，早晚期气切对预后影响和脱管方案等进行阐述。

Abstract: With the development of medicine, the common indications of tracheostomy in children have changed significantly, and children with prolonged mechanical ventilation have become the main population for tracheostomy in intensive care units. Tracheostomy has also become one of the common interventions in pediatric intensive care units, but there is no clear consensus on the length of time that endotracheal intubation should be maintained in children until tracheostomy. Many literatures suggest that early tracheotomy will shorten the length of ICU stay, total hospital stay, duration of mechanical ventilation, and duration of sedation, but it has different effects on mortality and the incidence of ventilator-associated pneumonia. However, the specific timing of tracheotomy needs to be combined with the patient’s condition and underlying disease. The purpose of this article focuses on the tracheostomy’s development, indications, methods, advantages and disadvantages of tracheostomy, nursing and common complications, prognosis between early tracheostomy, and weaning options.