Management of the Extubation Problem in the Premature Child
Management of the Extubation Problem in the Premature Child
复制标题
早产儿拔管问题的处理
DOI：
10.1177/000348948008900604
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发表时间：
1980
期刊：
影响因子：
--
通讯作者：
A. Seid
中科院分区：
文献类型：
--
作者：
R. Cotton;A. Seid
长期气管插管是在新生儿时期给予通气支持的一种广泛建立的手段。虽然早产儿对这种长期插管的耐受性良好，但确实会发生喉部并发症，即使插管治疗的最初疾病过程已经解决，也可能无法拔管。在这种情况下，建议对上呼吸道进行仔细的内镜检查，以确定问题的部位。如果损伤部位为声门下水肿或粘膜溃疡，并且如果在取出气管内管后立即进行内窥镜检查时，由于水肿形成或水肿液充满压缩肉芽组织，声门下区域开始变窄，则在前方中线处切开环状软骨，留下气管内管作为支架，似乎是进行气管切开术的更好选择。在连续12例患者中，9例成功拔管。
Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.