LARENGEAL STENOSIS. EMERGENCY AID. TRACHEOSTOMY

Sonnik N. B.

LECTURES

Scentific article

Depending on the etiology of laryngeal stenosis pathomorphological changes are characterized by hypoxia and hypercapnia, leading to disruption of vital organs. There are mobilizing defense mechanisms: hemodynamic, respiratory, tissue and other reactions. To hemodynamic compensatory responses refer the following: increased vascular tone, tachycardia, increased cardiac output of blood circulation acceleration. The withdrawal of blood from the depot, hypertension in a large blood circulation. Increased erythropoiesis, vascular permeability, gas exchange, occur of metabolic acidosis, partial transformation of metabolism in tissues into anaerobic type. Disorder of mechanisms are accompanied by breathlessness, mobilizing of muscles, lungs’ ventilation increases. These and other protective mechanisms reduce hypoxia and hypercapnia and thus improve supply to vital organs, especially to the brain. Intensive development of a stenosis does not quickly activate defense mechanisms and as a result a paralysis vital functions occurs and even death. About cutting of the trachea is no single opinion. More accessible diverse cross-cut of the trachea. Especially this method should follow the children without damaging the anatomical integrity of the cartilage of the trachea. However, the cross-cut should not be more than 1/3 in the diameter of the trachea. Cut the trachea must be careful to avoid damaging the posterior wall of the trachea and esophagus. In addition, there is a vertical incision between the trachea and П-shaped section. Forming a permanent traсheostomy are wearing the tracheostomy cannula. Cannula is a foreign body that contributes to serious disorders — support of the inflammatory process in the field of stoma, injury of the wall of the trachea causing coughing, supports the production of mucus, formation of granulation and scar tissue. So today ways of forming a stable traсheostomy without wearing traсheocannula are developed. One of the most effective existing ways is the formation of a stable traсheostomy by exposure of the anterior wall of the trachea, trachea oval formation in the ring and filing tracheal mucosa perimeter defect. By the skin around the edges of the defect perforated oval ring set-prosthesis which lumen width is 1.5-2 times the diameter of the trachea, opening the edges tighten the ring and then sew the skin with mucous membranes of the trachea. There is a channel-free method of resistant traсheostomy. When on elastic thread with nickel titanium traсheostomy closure walls around the perimeter. This technique is functional and does not require carrying out additional measures for the maintenance of its lumen. Complications on tracheostomy can be divided into intraoperative, early and late postoperative. In carrying conicotomy palpation of the larynx are conical connection that connects the thyroid cartilage and cartilage. Conicotomy can not be called a kind of traсheostomy because it is held within the larynx. If it is done correctly, conicotomy complications do not apper, since topographically zone performance has major arterial and venous vessels, vital organs that can be damaged. Thus, laryngeal stenosis refers to emergency conditions and require the knowledge and skills to help the patient doctor in any specialty.

laryngeal stenosis, tracheostomy, conicotomy, cricoconicotomy

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«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 76-79 pages, index UDK 616.22-007.271-089.85