d-r Tawa An|u{eva

Specijalna bolnica za hirur{ki bolesti

Filip Vtori Skopje - Makedonija
noemvri, 2009
Cardiosurgery - Skopje

Definicija:
Traheotomija e procedura za obezbeduvawe na
di{en prooden pat vo cervikalnata trahea.
Na~in na postavuvawe
- operativen
- on bed side
-
- ( ,
)

Cardiosurgery - Skopje


3600. ...
800 B.C.
Homer- opis za Aleksander Veliki
So svojot me~ ja punktiral traheata na
vojnik koj se gu{el
400 B.C.
Hipokrat
ja prokolnal traheotomijata
Poradi strav od povreda na karotida
1546 Brasavolo- prva uspe{na
traheotomija
1957 [eldon prva perkutana
traheostoma
1969 Toj i Vanstajn prva traheostoma
po seldinger tehnika
1985 Paskal Ciaglija- dilataciona
perkutana traheostoma
Cardiosurgery - Skopje

(,
inominat a.,
jugular- ven)
Troid
E
Lar
Nerv
(Re.Larngeal)
Cervial i

Cardiosurgery - Skopje

Indikacii za Traheostoma:

- (, , )
- Infec (epiglotis, )
- Bilateral
- Trauma (larngeal, ma )
- Edema (, larngo)

-
-

- Subgloti
Cardiosurgery - Skopje

Indikacii za Traheostoma:

-




( )
(
, -
,
)
Neuromusular -

Cardiosurgery - Skopje

Indikacii za Traheostoma:

miscellaneous
(traheomalaia,
subgloti ,
(Pierre Robin, Triecher Collins
sndrom)
Obstrutive Sleep Apnea Sndrom
Aspirai
Pro (
,
)
Cervi-

Cardiosurgery - Skopje

Cardiosurgery - Skopje




(
)

Cardiosurgery - Skopje


(PT, PTT, INR)

Cardiosurgery - Skopje

Cardiosurgery - Skopje


()
1955, Shelden .

1985, Ciaglia per

(PDT)

1989, Schachner . Rapitrach

1990, Griggs .

(GWDF)

Cardiosurgery - Skopje

(
)
-


: 75 .

Di

Cardiosurgery - Skopje

Prednosti
Nema transfer vo operaciona sala
Smith et al. 1990 Incidenca na komplikacii
pri transfer do operaciona sala 33%
Pokratko vreme ~ekawe da se implantira
traheostomata
Nema lista na ~ekawe
poevtina
US studii - za{teda $1,200 - $3,300 /
Vo komparacija so operativniot tretman
Cardiosurgery - Skopje

Tipovi na dilatativni tehniki

Plastic Dilator
Ciaglia Technique
Forcep Dilator
Rapitrach
Griggs Technique
Drugi
Fantoni Translaryngeal
Technique
PercuTwist

Cardiosurgery - Skopje

Cardiosurgery - Skopje

Ciaglia tehnika
1985
- Dilatacija
- Seldinger tehnika
- Slepo plasirawe
- Verificirano
spored tidal volumeni
- Me|u krikoidna i prv
trahealen ring,

Cardiosurgery - Skopje

omplia
70%
2-3%

66%

omplia-
Apnea .
.
False root -

Pneumot
()
- ,

Post-obstrutive
H
Ar
Cardiosurgery - Skopje

omplia -
:


Tra
Cel

Sub
Atele

Cardiosurgery - Skopje

omplia -
- traheoinominat fistula
Traheo- larngomala
Steno
Traheoeoageal fistula
Traheoutan fistula
Granula

Cardiosurgery - Skopje

 -
situa
, ,






( 4-5
)

Cardiosurgery - Skopje


???
-

: ,
,
(-
).
: internist, intenivist,
pulmonolog

Cardiosurgery - Skopje


? . .. bed site
Bed site -

ICU (n
)
(,
diatermia,
)
(,
asistnt,
anesteiolog)

Cardiosurgery - Skopje

 - ?
(
, )
Normal protetiv larngeal mehanim (
, )
plan (radioterap,
)

Cardiosurgery - Skopje

Ultra perc Smiths tehnika

(edine~en dilatator)

Cardiosurgery - Skopje

Na{i iskustva
Metodata e vovedena 05/2004
Edukacija dobiena vo Deutsche
Herz Centrum Berlin
40

K
- Krvarewe od a.inominata


-

-

Cardiosurgery - Skopje

Cardiosurgery - Skopje