总结1例A型主动脉夹层伴Ⅳ级困难气道患者行主动脉夹层手术及悬雍垂腭咽成形术后患者的护理体会。 针对该患者血流动力学紊乱、容量失调等问题,采取维持血流动力学稳定及容量的动态平衡措施;针对患者发生急性呼吸功能不全,采用个体化肺保护性通气措施,预防呼吸机相关性肺炎;根据主动脉夹层术后伴Ⅳ级困难气道的护理难点和重点,建立紧急人工气道预案,预防非计划拔管及咽喉部出血,实施序贯式气管插管的拔管流程;根据该患者具有谵妄发生的高风险,给予风险层级管理,强化阶段性早期活动。经过31 d精细化护理,患者康复出院。
To summarize the nursing experience of a patient with type A aortic dissection and grade Ⅳ difficult airway who underwent aortic dissection surgery and uvulopalatopharyngoplasty. In view of the patient's hemodynamic disorders,volume disorders and other problems,we maintained hemodynamic stability and volume dynamic balance. For acute respiratory insufficiency,individualized lung protective ventilation measures were adopted to prevent ventilator-associated pneumonia. According to the nursing difficulties and emphases of the airway with grade Ⅳ difficulty after aortic dissection,emergency artificial airway preplan was established to prevent unplanned extubation and throat bleeding,and sequential tracheal intubation extubation was implemented. The patient was given a risk hierarchy based on his high risk of delirium,early stage activities were enhanced. After 31 days of intensive care,the patient recovered well and was discharged.
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