تعريف

Tracheotomy is the surgical creation of an opening from the outside of the neck into the windpipe. A tube is inserted into the opening to allow for normal breathing. It is done to bypass obstructions that are interfering with breathing. The opening is called a stoma or tracheostomy. A stoma may be either temporary or permanent.

In an emergency, a cricothyroidotomy may be done. This type of airway should only be used temporarily. If the airway will be needed for more than 48 hours, a standard tracheotomy will be done.

بضع القصبة الهوائية

أسباب هذا الإجراء

A tracheotomy is used to create an open airway. It is done to restore normal breathing in the following situations:

  • The airway is obstructed at or above the level of the larynx (voice box), due to:
    • Trauma to the neck area
    • Obstructing tumors in the upper airway
  • Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
    • Spinal cord injury in the neck area
    • Severe lung infection or inflammation
  • Injury to the respiratory tract due to breathing in smoke or steam or inhaling corrosive substances
  • Birth defects of the trachea or larynx
  • Foreign object blocking the trachea or larynx
  • Severe sleep apnea

المضاعفات المحتملة

If you are planning to have a tracheotomy, your سيقوم الطبيب بمراجعة القائمة من المضاعفات المحتملة، والتي قد تشمل:

  • نزيف
  • العدوى
  • Damage to the vocal cords, vocal cord nerves, or esophagus
  • Damage to the lungs
  • صعوبة في البلع
  • الدم المنخفض ضغط
  • Tracheostomy tube displacement or damage
  • Scarring at the site of operation leading to closure of the tracheostomy

بعض العوامل التي قد تزيد من خطر المضاعفات تشمل:

  • Age: infants and elderly adults
  • السمنة
  • التدخين
  • سوء التغذية
  • Recent illness, especially an upper-respiratory infection
  • إدمان الكحول
  • Long-term illnesses
  • Use of certain prescription and nonprescription drugs

ما يمكن توقعه

قبل الإجراء

طبيبك سوف المرجح أن تفعل ما يلي:

  • Chest x-ray —a test that uses radiation to take a picture of structures inside the body
  • اختبارات الدم والبول
  • استعراض الأدوية

التحدث مع طبيبك عن الأدوية الخاصة بك. قد يطلب منك التوقف عن تناول بعض الأدوية تصل إلى أسبوع واحد قبل العملية مثل:

  • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
  • أدوية تسييل الدم ، مثل الوارفارين (الكومادين)
  • الأدوية المضادة للصفائح الدموية ، مثل كلوبيدوجريل (بلافيكس)

التخدير

General anesthesia will be used. You will be asleep. In emergency situations, local anesthesia may be used. It will numb the area.

الوصف الداخلي

A cut will be made in the skin of the neck. A section at the front of the windpipe will be removed. A tracheostomy tube, which will act as the airway, will then be fitted into this opening in the windpipe. The skin will be closed around the tube with stitches or clips.

You will breathe through this tube as long as it is in place. Oxygen and machines to assist breathing will be provided, if needed.

You will not be able to speak when the tube is in place unless you put a finger or other covering over the tube. This is because all the air going in and out of the tube bypasses the vocal cords.

مباشرة بعد الإجراء

A chest x-ray may be needed.

كم من الوقت سيستغرق ؟

About 15-30 minutes

كم هو مؤلم ؟

Anesthesia prevents pain during the procedure. You may have some pain and soreness during recovery. Your doctor can prescribe pain medicine to help relieve this discomfort.

متوسط ​​الإقامة في المستشفى

The length of stay will depend on the reason for the procedure. Most stays are 1-5 days.

رعاية ما بعد العملية

  • Keep the stoma area clean. Clean it daily with mild soap and water or with hydrogen peroxide. Replace the dressing with a clean dry one.
  • اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
  • Learn the proper daily care of your tracheostomy tube . This will help maintain its function. Care includes the following, which you will be taught shortly after the surgery:
    • Cleaning the tube
    • Suctioning the tube regularly to keep it from becoming blocked with secretions
    • Humidifying the air you breathe
    • Covering the tracheostomy hole with a scarf or other cloth when going outside, so that dust, dirt, and other foreign particles cannot get in
    • Being very cautious about breathing in water or small particles through the tracheostomy (such as food bits, powders, aerosol sprays, dust)
    • Covering the tracheostomy hole with your fingers in order to speak
  • Consult a speech therapist if recommended by your doctor.
  • Take antibiotics, if prescribed by your doctor.
  • Return to daily activities and work as soon as possible to promote healing.
  • Avoid vigorous exercise for six weeks after surgery.
  • تأكد من اتباع تعليمات طبيبك.

Once a tracheostomy tube is in place, you will experience breathing and vocal changes. It usually takes three days to adjust to breathing through the tube. Speaking is often a larger adjustment. Initially, you may not be able to speak.

استدعاء الطبيب

بعد مغادرة المستشفى، اتصل بطبيبك في حالة حدوث أي مما يلي:

  • Signs of infection, including cough, excessive foul-smelling mucous, fever, and chills
  • احمرار أو تورم أو ألم متزايد أو نزيف شديد أو أي إفرازات من موقع الشق
  • الغثيان و / أو القيء الذي لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك بعد الجراحة ، أو التي تستمر لأكثر من يومين بعد الخروج من المستشفى
  • ألم لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك
  • السعال، ضيق التنفس، أو ألم في الصدر
  • أعراض جديدة غير مبررة
  • Tracheostomy tube falls out and you cannot replace it–Call for medical help right away.

في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.

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