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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medalphabet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский алфавит</journal-title><trans-title-group xml:lang="en"><trans-title>Medical alphabet</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2078-5631</issn><issn pub-type="epub">2949-2807</issn><publisher><publisher-name>ООО «Альфмед»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.33667/2078-5631-2022-9-75-80</article-id><article-id custom-type="elpub" pub-id-type="custom">medalphabet-2643</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Статьи</subject></subj-group></article-categories><title-group><article-title>Особенности ведения пациентов, перенесших классическую и пункционно-дилатационную трахеостомию в отделениях реанимации и интенсивной терапии</article-title><trans-title-group xml:lang="en"><trans-title>Management of patients who underwent classical and percutaneous tracheostomy in intensive care units</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8483-2530</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Крюков</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Kryukov</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Крюков Андрей Иванович, д. м. н., проф., член-корр. РАН, заслуженный деятель науки РФ, директор; зав. кафедрой оториноларингологии имени академика Б. С. Преображенского лечебного факультета</p><p>Scopus: 7004791793</p><p>Москва</p></bio><bio xml:lang="en"><p>Kryukov Andrey I., DM Sci (habil.), professor, RAS corresponding member, honored worker of science of the Russian Federation, director; head of Dept</p><p>Scopus: 7004791793</p><p>Moscow</p></bio><email xlink:type="simple">nikio@zdrav.mos.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4795-4445</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кирасирова</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kirasirova</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кирасирова Елена Анатольевна, д. м. н., проф. научно-исследовательского отдела реконструктивной хирургии полых органов шеи; проф. кафедры оториноларингологии имени академика Б. С. Преображенского лечебного факультета</p><p>Scopus: 26635451000</p><p>Москва</p></bio><bio xml:lang="en"><p>Kirasirova Elena A., DM Sci (habil.), professor at Research Dept of Reconstructive Surgery of Hollow Organs of the Neck; professor at Dept</p><p>Scopus: 26635451000</p><p>Moscow</p></bio><email xlink:type="simple">43lor@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2919-2304</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лафуткина</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Lafutkina</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лафуткина Надежда Васильевна, к. м. н., с. н. с. научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Scopus: 14015763800</p><p>Москва</p></bio><bio xml:lang="en"><p>Lafutkina Nadezhda V., PhD Med, senior researcher, Research Deptof Reconstructive Surgery of Hollow Neck Organs</p><p>Scopus: 14015763800</p><p>Moscow</p></bio><email xlink:type="simple">43lor@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7577-8672</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Наринян</surname><given-names>Н. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Narinyan</surname><given-names>N. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Наринян Нарине Кареновна, к. м. н., врач-оториноларинголог</p><p>Москва</p></bio><bio xml:lang="en"><p>Narinyan Narine K., PhD Med, otorhinolaryngologist</p><p>Moscow</p></bio><email xlink:type="simple">narine.narinyan@bk.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4309-7482</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мамедов</surname><given-names>Р. Ф.</given-names></name><name name-style="western" xml:lang="en"><surname>Mamedov</surname><given-names>R. F.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мамедов Рамис Фирудунович, к. м. н., с. н. с. научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Москва</p></bio><bio xml:lang="en"><p>Mamedov Ramis F., PhD Med, senior researcher of Research Dept of Reconstructive Surgery of Hollow Organs of the Neck</p><p>Moscow</p></bio><email xlink:type="simple">43lor@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2161-9534</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Резаков</surname><given-names>Р. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Rezakov</surname><given-names>R. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Резаков Руслан Анатольевич, к. м. н., н. с. научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Scopus: 56503401200</p></bio><bio xml:lang="en"><p>Rezakov Ruslan A., PhD Med, researcher of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Scopus: 56503401200</p><p>Moscow</p></bio><email xlink:type="simple">43lor@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1446-5346</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кулабухов</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kulabukhov</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кулабухов Егор Владимирович, н. с. научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Scopus: 57214749347</p><p>Москва</p></bio><bio xml:lang="en"><p>Kulabukhov Egor V., researcher of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Scopus: 57214749347</p><p>Moscow</p></bio><email xlink:type="simple">kulabukhov93@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9043-4205</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фролкина</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Frolkina</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фролкина Екатерина Алексеевна, аспирант научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Москва</p></bio><bio xml:lang="en"><p>Frolkina Ekaterina A., graduate student of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Moscow</p></bio><email xlink:type="simple">frolkina_ea@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2270-7483</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тютина</surname><given-names>С. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Tyutina</surname><given-names>S. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тютина Светлана Игоревна, аспирант научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Москва</p></bio><bio xml:lang="en"><p>Tyutina Svetlana I., graduate student of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Moscow</p></bio><email xlink:type="simple">lana.tyutina@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3258-8780</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Миронова</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Mironova</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Миронова Дарья Алексеевна, аспирант научно-исследовательского отдела реконструктивной хирургии полых органов шеи</p><p>Москва</p></bio><bio xml:lang="en"><p>Mironova Daria A., graduate student of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Moscow</p></bio><email xlink:type="simple">mironova2001@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3258-8780</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Юматова</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Yumatova</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Юматова Дарья Александровна, аспирант научно-исследовательского отдела реконструктивной хирургии полых органов шеи, кафедра оториноларингологии имени академика Б. С. Преображенского лечебного факультета</p><p>Москва</p></bio><bio xml:lang="en"><p>Yumatova Daria A., graduate student of Research Dept of Reconstructive Surgery of Hollow Neck Organs</p><p>Moscow</p></bio><email xlink:type="simple">43lor@mail.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2275-0307</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Трусов</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Trusov</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Трусов Владислав Алексеевич, врач-ординатор</p><p>Scopus: 57214749347</p><p>Москва</p></bio><bio xml:lang="en"><p>Trusov Vladislav A., resident physician</p><p>Scopus: 57214749347</p><p>Moscow</p></bio><email xlink:type="simple">dr.trusov@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ «Научно-исследовательский клинический институт оториноларингологии имени Л. И. Свержевского Департамента здравоохранения Москвы»; ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Clinical Institute of Otorhinolaryngology n. a. L. I. Sverzhevsky; Russian National Research Medical University n. a. N. I. Pirogov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ «Научно-исследовательский клинический институт оториноларингологии имени Л. И. Свержевского Департамента здравоохранения Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Clinical Institute of Otorhinolaryngology n. a. L. I. Sverzhevsky</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow City Clinical Hospital n. a. V. M. Buyanov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian National Research Medical University n. a. N. I. Pirogov</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2022</year></pub-date><pub-date pub-type="epub"><day>06</day><month>06</month><year>2022</year></pub-date><volume>0</volume><issue>9</issue><issue-title>Кардиология. Современная функциональная диагностика. Неотложная медицина (1)</issue-title><fpage>75</fpage><lpage>80</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Крюков А.И., Кирасирова Е.А., Лафуткина Н.В., Наринян Н.К., Мамедов Р.Ф., Резаков Р.А., Кулабухов Е.В., Фролкина Е.А., Тютина С.И., Миронова Д.А., Юматова Д.А., Трусов В.А., 2022</copyright-statement><copyright-year>2022</copyright-year><copyright-holder xml:lang="ru">Крюков А.И., Кирасирова Е.А., Лафуткина Н.В., Наринян Н.К., Мамедов Р.Ф., Резаков Р.А., Кулабухов Е.В., Фролкина Е.А., Тютина С.И., Миронова Д.А., Юматова Д.А., Трусов В.А.</copyright-holder><copyright-holder xml:lang="en">Kryukov A.I., Kirasirova E.A., Lafutkina N.V., Narinyan N.K., Mamedov R.F., Rezakov R.A., Kulabukhov E.V., Frolkina E.A., Tyutina S.I., Mironova D.A., Yumatova D.A., Trusov V.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-alphabet.com/jour/article/view/2643">https://www.med-alphabet.com/jour/article/view/2643</self-uri><abstract><p>В статье обобщены показания к выполнению классической трахеостомии (КТС) и пункционно-дилатационной трахеостомии (ПДТ) у больных, находящихся на искусственной вентиляции легких в отделении реанимации и интенсивной терапии. По результатам анализа 502 историй болезни определены преимущества и недостатки различных видов трахеостомии. Изучена микробиота трахеобронхиального дерева 40 пациентов после ПДТ, описан алгоритм послеоперационного ведения больных, перенесших трахеостомию в ОРИТ, эндоскопические методы диагностики и лечения постинтубационных изменений в гортани и трахее, отражены основные аспекты послеоперационного ухода. Пересмотрен подход к деканюляции пациентов, позволяющий сократить длительность госпитализации пациентов.</p><p>Результаты. Среди пациентов после ПДТ (первая группа; n = 164) наблюдалось 25 (15,2 %) осложнений. Интраоперационные (n = 4; 16 %): 3 (12 %) технически сложных случая, когда ПДТ пришлось продолжить хирургическим путем; 1 (4 %) случай подкожной эмфиземы. Послеоперационные осложнения (n = 21, 84 %): 4 (16 %) случая трахеопищеводных свища, 2 (8 %) случая трахеомедиастинальных свища (ТМС), 2 (8 %) случая кровотечения, 2 (8 %) случая двустороннего пареза гортани и 2 (8 %) случая эрозивно-язвенного трахеита III степени, 6 (24 %) случаев выраженного грануляционного процесса в шейном отделе трахеи; 3 (12 %) пациентам в позднем послеоперационном периоде потребовалось проведение ретрахеостомии. По данным микробиологического исследования на 1–3-и сутки преобладали Klebsiella pneumoniae и Pseudomonas aeruginosa, на 5–7-е сутки – Proteus mirabilis и Acinotobacter spp., на 10-е сутки отмечалось наличие Сandida spp. Среди пациентов после КТС (вторая группа; n = 338) осложнения отмечались у 20 (5,9 %), среди которых – 3 (15 %) интраоперационных: 1 (5 %) случай пневмоторакса, 2 (10 %) случая повреждения мембранозной стенки трахеи с развитием ТМС. Послеоперационные осложнения составили 17 (85 %) случаев, среди которых 4 (20 %) случая стеноза трахеи, 2 (10 %) случая ретрахеостомии, 2 (10 %) случая трахеомедиастинального свища, 3 (15 %) случая выраженного грануляционного процесса в области трахеостомы, 1 (5 %) случай двустороннего пареза гортани, 3 (15 %) случая эрозивно-язвенного трахеита III степени, 1 (5 %) случай пролежня верхней трети задней стенки трахеи, 1 (5 %) случай ТПС.</p></abstract><trans-abstract xml:lang="en"><sec><title>Objectives</title><p>Objectives. The article summarizes the indications for surgical tracheostomy (STS) and puncture dilatation tracheostomy (PDT) in patients who underwent mechanical ventilation in the intensive care units (ICU). Based on analysis of 502 case histories, the advantages and disadvantages of different types of tracheostomies were determined. The microbiota of the tracheobronchial tree of 40 patients after PDT was studied, the algorithm of postoperative management of patients who underwent tracheostomy in the ICU was described. We also reviewed endoscopic diagnostic and treatment methods for postintubation changes in the larynx and trachea and the main aspects of postoperative care. The revised approach to decannulation of patients allowed to reduce the duration of hospital stay.</p></sec><sec><title>Results</title><p>Results: Among patients after PDT (group 1; n = 164), 25 complications (15.2 %) were observed. Intraoperative complications (n = 4, 16 %): 3 technically difficult cases (12 %), when PDT had to be continued as an open surgical procedure; 1 case (4 %) of subcutaneous emphysema. Postoperative complications (n = 21, 84 %): 4 cases (16 %) of tracheoesophageal fistulas (TEF), 2 cases (8 %) of tracheomediastinal fistulas(TMF), 2 cases (8 %) of bleeding, 2 cases (8 %) of bilateral paresis of the larynx and 2 cases (8 %) of grade III ulcerative tracheitis, 6 cases (24 %) of a granulation process in the cervical trachea; 3 patients (12 %) required retracheostomy in the late postoperative period. According to the microbiological study, Klebsiella pneumoniae and Pseudomonas aeruginosa prevailed on days 1–3, Proteus mirabilis and Acinotobacter sp. on days 5–7, and Candida sp. was noted on day 10. Among patients after STS (group 2; n = 338), complications were noted in 20 (5.9 %), including 3 (15 %) intraoperative: 1 case (5 %) of pneumothorax, 2 cases (10 %) of damage to the membranous wall of the trachea with thedevelopment of TMF. Postoperative complications were observed in 17 cases (85 %), including 4 cases (20 %) of tracheal stenosis, 2 cases (10 %) of retracheostomy; 2 cases (10 %) of TMF; 3 cases (15 %) of a granulation process in the tracheostomy area, 1 case of bilateral paresis of the larynx (5 %), 3 cases (15 %) of grade III ulcerative tracheitis; 1 case (5 %) of mucosal pressure ulcer of the upper third of the posterior wall of the trachea, 1 case (5 %) of TEF.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>трахеостомия</kwd><kwd>пункционно-дилятационная трахеостомия</kwd><kwd>осложнения трахеостомии</kwd><kwd>искусственная вентиляция легких</kwd></kwd-group><kwd-group xml:lang="en"><kwd>tracheostomy</kwd><kwd>percutaneous dilational tracheostomy</kwd><kwd>complications of tracheostomy</kwd><kwd>artificial lung ventilation</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Кривонос В. 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