기관지 절개술후의 중증합병증

초록

Tracheotomy is a relatively simple operative procedure and should be recommended whenever the patient’s ability to maintain an airway or remove secretion is seriously impaired. The complications that develop are generally due to faulty surgical technique. Although the risks of the operative procedure are negligible, the postoperative sequelae and complications may produce disability with subsequent long period of treatment before recovery and sometimes fatal. Three adult patients who were complicated with difficult extubation and hemorrhage following tracheotomy for craniocerebral injury are presented. Difficult extubation of canula was seen in a patient whose lumen of the trachea was narrowed by granulation tissue. Whenever the canula was withdrawn the patient became cyanotic with difficulty in respiration. Removal of the granulations that formed on the anterior tracheal wall at the site of the opening and change of tracheotomy site could solve the difficulty. Sudden critical hemorrhage long after the tracheotomy were observed in two patients at the time of extubation of canula. One patient was tracheotomized for 13 days and the other 70 days when they died respectively of the fatal hemorrhage. No autopsy was done, but it could be suspected that the late hemorrhage might have to do with pressure erosion of a large vessel that had been pressing on by the end or the edge of canula.