소아청소년 기관 절개술의 원인과 임상 경과
Causes and Outcome of Tracheostomy in Children
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목 적 : 기관 절개술은 소아의 호흡기 관리에서 기도 유지에 도움을 주어 생명을 구하는 술기이지만 이에 따른 심각한합병증의 위험도있다. 본 연구에서는국내소아청소년 기관절개술의 임상 양상과 결과에 대해서 알아보고자 한다. 방 법: 1995년 1월부터 2010년 7월까지 삼성서울병원에서기관절개술을시행한18세미만인환자153명을대상으로 의무기록을 후향적으로 검토하여 성별, 기관 절개술을시행한 나이, 응급 수술 여부, 원인, 기관절개술 전경구 기관 내 삽관 기간, 캐뉼라 발관 여부, 캐뉼라 발관까지 걸린기간, 전체입원기간, 기관 절개술 후 입원 기간, 기관 절개술의합병증 그리고 퇴원, 전원, 사망한환자 수를 조사하였다. 결 과 : 성문하 협착으로 기관 절개술을 받은 환자가 가장많았다(29명, 19%). 소아청소년 기관 절개술이 시행된 중간 나이는 1.3세(범위, 22일-17.8세)였으며, 73명(47.7%)이 1세 미만이었다. 1세 미만에서는 호흡기 질환이, 1세 이상에서는 신경근육 질환이 유의하게많았다.(P=0.013) 가장 흔한 합병증은 기도 부위 혹은 기도 누공의 육아조직 형성(56명, 36.6%)이었다. 성공적으로 캐뉼라 발관을 한 환자는 61명(39.9%)이었으며 캐뉼라 발관까지걸린 중앙 기간은 141일(범위, 1-2,529일)이었다. 사망한 환자는 16명(10.5%)이었으나, 기관 절개술과 직접적 관련되어 사망한환자는 1명(0.7%)이었다. 결론:소아청소년기관 절개술은 비교적안전하였다. 신경근육 질환 환자들이 호흡기 질환 환자에 비해서 기관 절개술을 시행할 때의 나이가 많았고, 캐뉼라 발관이 잘 되지않았으며, 재원 기간이 길었다.
Abstract
Purpose: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. Methods: We performed a retrospective chart review of 153 patients, less than 18 years of age,who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications,durations, complications and mortality were evaluated. Results: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P =0.013). Stoma or tracheal granuloma formation (36.6%)was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. Conclusion: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management.
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