Objective To investigate the reasons for tracheal granulomatosis in the elderly undergoing mechanical ventilation after tracheotomy, and to investigate the preventing and treating methods. Methods It was retrospectively analyzed of the clinical data of 179 patients more than 60 years old, who underwent tracheotomy because of various reasons from February 2007 to November 2010. Among these patients, 12 patients developed granuloma inside the trachea. The possible reasons and pathogenesy of granulomatosis were analyzed, and the experience of diagnosis and treatment was summarized. Results The tracheal cannula used in 12 patients was made of disposable silicification polyvinyl chloride (PVC) with air bag and without core. The longest span of taking canula was 41 months, the shortest was 6 months, and the average span was 9 months. The time of most of the endotrachea granulomas needed to develop was 3 to 9 months after tracheotomy, and the average time was about 6 months. Twelve patients showed different clinical situations, including dyspnea, breath holding, increased air pressure, increased heart rates and blood in sputum. Flap-like granuloma in 2 patients was removed by operation with fiber bronchus endoscope. Another 2 patients were cured by changing self-made long tracheal cannula. The rest 7 patients received expectant treatment. One died of suffocation caused by airway obstruction after big hemoptysis. Conclusions Gerontal patients with long-term mechanical ventilation might develop endotrachea granuloma. Clinical characteristics should be recognized, and diagnosis and treatment should be given in time. Most small granulomas could be cured by expectant treatment. As to the big ones, operated extirpation should be given as soon as possible. Extubate will be done when the condition is all ready. For those patients who need long-term canula, while don't need long time mechanical ventilation, metal canulas with canulas inside which seldom caused granulomas should be used.%目的 探讨＞ 80岁老年人气管切开术后机械通气患者并发气管内肉芽肿形成原因及防治方法.方法 回顾性分析研究2007年2月至2010年11月我院收治的≥60岁因各种病因行气管切开术179例患者的临床资料,其中12例并发气管内肉芽肿,分析肉芽肿形成的可能因素及发病机制,总结诊疗经验. 结果 12例患者使用的气管套管均为一次性带气囊无内芯的硅化聚氯乙烯套管,带管时间最长为6 ～41月,平均为9月.气管内肉芽肿多发生在气管切开术后3～9月,平均6月左右.12例患者均有不同程度呼吸困难、憋气、气道压力增高、心率增快、痰中带血.2例活瓣样肉芽肿在纤支内镜下手术摘除.另2例更换自制长气管套管治愈,7例行保守治疗治愈.1例因大咯血致气道阻塞引起窒息死亡. 结论 长期行机械通气老年患者有并发气管内肉芽肿可能,应了解其临床特点,及时诊断治疗.大多数较小肉芽肿可用保守方法治愈,对于较大肉芽肿应尽早手术摘除.当具备拔管条件时应尽早拔管.对长期带管,但有较长时间不需要机械通气病人,应使用较少引起肉芽肿的带有内套管的金属套管.
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