脳神経外科における経皮的気管切開術—9症例の経験

Percutaneous Dilational Tracheostomy : report of 9 cases

I．はじめに

　脳神経外科領域においては遷延性意識障害，それに引き続き生じる難治性肺炎などにより気管切開術を余儀なくされることが多い．一般に気管切開術は，外科的に気管を露出し直視下にカニュレイションする方法で，手術室あるいは病棟のICUにおいて施行されている．

　経皮的気管切開術（以下PDTと略す）は1985年にCiagliaらにより初めて報告された気管切開術の手術法の一つで^2），報告者により若干方法が異なるものの^5,14），簡便さの故に世界的に広く普及しつつあるようである．

Nine patients with CNS damage who had been transferred to our critical care unit were treated with acommercially available kit for percutaneous dilational tracheostomy (PDT). The mean procedure time wasabout 11 minutes, and the perioperative complication rate was 22% (2/9). Only one complication, woundinfection, occurred, and the patient was cured with conventional therapy. On the other hand, premature ex-tubation of the translaryngeal tube occurred in one case. Long-term complications like tracheal stenosisand tracheal malacia were not experienced in two patients. They were discharged from the hospital afterdecannulation. In conclusion, the advantages of PDT include a short procedure time, the ability to performthe procedure at the bedside, and reduced stimulation of the trachea. Because of the safety and simplicityof the procedure, we recommend PDT for patients with CNS damage.