气管切开的气道护理

L/O/G/O气管切开的气道护理气管切开的气道护理-ICU胡新 气管切开术是临床抢救和治疗呼吸道梗阻患者的重要措施之一。作为有创的人工气道，由于呼吸道的改路，空气未经鼻腔湿化过滤，而直接与下呼吸道相通，由此造成呼吸道分泌粘稠、干燥、结痂，痰液不易咳出而加重呼吸道阻塞，造成肺部感染。因此，气管切开术后护理一直是护理人员在临床工作中不断研究和探索的重要课题，随着医学科学不断发展和医疗护理质量的不断提高，对这一课题的研究也有了更新的突破。现将笔者多年的临床实践中的体会浅述如下。1 正确的体位放置为了减轻气管下端压迫，损伤气管内壁，并防止胃内容物反流引起吸入性肺炎，气管切开术病人应取半卧位，颈下略垫高，使颈伸展，保持呼吸道通畅。2 套管固定要牢固系带打手术结，松紧度适宜，太紧可压迫颈部血管，太松套管容易脱出，应以放入1指为宜。并经常观察有无活动性出血，皮下气肿、气胸、感染等并发症的出现。3 合理用氧 3.1 氧气的湿化 临床常规用蒸馏水，生理盐水作为湿化液，每天更换一次。3.2 氧气的温化 最佳方法是使用新型加温吸氧装置，使患者感觉呼吸温和舒适、通畅、咳痰容易，可提高氧疗效果。3.3 血氧饱和度（SpO 2）监测 根据SpO 2 的指标，随时调整氧流量，做到合理有效地给氧。4 保持呼吸道有效湿化 首先每26h行超声雾化吸入一次，保持呼吸道湿润，以利于分泌物的排除。其次间歇气管内直接滴入湿化液，每隔1530min一次，每次12ml。最后套管口外敷两层湿纱布，起湿化过滤空气的作用。5 保证有效痰液引流，以保持呼吸道通畅临床在实践中，我们总结了三步排痰顺序。即:一吸、二拍、三吸。5.1 一吸 即吸入药物。通过气管滴药或雾化吸入将药物吸入支气管及肺内，起到溶解、稀释干燥痰液及杀菌作用，使粘痰变稀易于咯出。常用药物有-糜蛋白酶、庆大霉素、地塞米松等5.2 二拍 即翻身拍背。吸入药物后协助病人翻身，叩击背部，使药物与粘痰充分接触后发挥药效。在翻身的同时注意各种导管以防脱开。拍背应自下向上，以边缘到中央，手成勺状以增加共振力量，使痰松动，同时嘱病人咳嗽，将痰咯出。5.3 三吸 即吸痰。由于危重病人咳嗽无力或因昏迷咳嗽反射消失，即便采用上述方法仍不能有效排痰，此时应予吸痰。（1）根据病人咳嗽有痰，呼吸不畅，听诊有罗音或痰鸣音，SpO 2 下降时，进行吸痰，做到及时吸痰，有效吸痰。（2）吸痰前后给予充分吸氧，可避免因吸痰而引起的低氧血症。（3）选择适宜的吸痰管，吸痰管的外径应小于气管内管直径的1/2为宜，以免吸管太粗影响气体进入及负压过大而造成肺不张。（4）吸痰时将吸引管徐徐插入内套管，待吸管达到一定深度，向上提取时再缓慢转动吸引，遇有分泌物多时宜稍停留，防止将其痰液推下，一般吸引以不超过3次为宜，否则不易保持血氧饱和度正常。（5）吸痰时应注意监测心率、心律、血压和SpO 2，如果病人出现心动过缓、早搏、血压下降，甚至意识有变化，则需要停止操作，给予吸氧或呼吸机辅助呼吸。6 医源性呼吸道感染的控制6.1 气管内套管消毒 每隔46h进行消毒一次，常用煮沸消毒。6.2 严格无菌操作 尤其是吸痰时，戴无菌手套，吸痰管每次更换，在口腔和气道同时吸痰时，应遵循先气管后口腔的原则。6.3 气管切开部位局部换药 每日2次，保持切开部位敷料清洁干燥，若有分泌物污染时应及时更换。6.4 加强口腔护理 每日24次，最好选用1.5%碳酸氢钠溶液或生理盐水。6.5 器械消毒 各种医用导管、器具、雾化器接管、氧气湿化瓶等，应严格进行消毒处理，防止吸入的气体或药物被细菌污染。6.6 保持病室内空气清新 每日紫外线消毒一次，室内温度2022，湿度60%70%。对于每例施行气管切开术的病人，术后的护理有着举足轻重的作用，如果从以上几点做起，就会减少或避免一些术后的并发症，如肺部感染、呼吸道阻塞等。ContentsLOGOThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Description of the contentsDescription of the contentsDescription of the contentsDescription of the contentsDescription of the contentsHot TipHow do I incorporate my LOGO and URL to a slide that will apply to all the other slides?On the View menu,point to Master,and then click 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