总结甘肃省积石山县4例呼吸道梗阻地震伤员气管切开后早期拔管的护理经验。拔管前科学气道湿化、精细气囊管理、早期佩戴说话瓣膜;拔管时全面评估堵管风险、循序渐进堵管试验、多学科实施拔管;拔管后序贯通气过渡。4例患者经过22~26 d规范诊疗和精心护理,康复出院。出院2个月随访,均恢复良好。
兰旭红
,
郭龙飞
,
彭彩丽
,
蒋由飞
,
汤雪梅
,
张丽琴
,
傅彩虹
,
郑小明
,
周红芳
,
张志刚
. 地震伤员气管切开后早期拔管的护理实践[J]. 中华急危重症护理杂志, 2024
, 5(9)
: 837
-839
.
DOI: 10.3761/j.issn.2096-7446.2024.09.012
To summarize the nursing experience of early extuation after tracheostomy in 4 cases of earthquake casualties with respiratory obstruction in Jishishan County,Gansu Province. Scientific airway humidification before extubation,fine balloon management,early wearing of speech valve were implemented. During extubation,the risk of extubation should be evaluated comprehensively,the extubation test should be carried out step by step and multi-disciplinary extubation was carried out. Sequential ventilation transition was provided after extubation. After 22~26 days of standardized diagnosis and treatment and meticulous nursing,the 4 patients were discharged from the hospital,and all of them recovered well during 2 months of follow-up.
[1] Liu SJ,He CQ.Related factors associated with earthquake in-patient mortality[J]. Disaster Med Public Health Prep,2022,16(1):65-70.
[2] 项丽君,王园,罗彦嗣,等. 成人气管切开相关压力性损伤预防的最佳证据总结[J]. 中华护理教育,2023,20(2):229-236.
Xiang LJ,Wang Y,Luo YS,et al.Summary of the best evidence for the prevention of tracheostomy-related pressure injury in adults[J]. Chin J Nurs Educ,2023,20(2):229-236.
[3] 李勍,姜宏英,周婷,等. 气管切开术后拔管困难患者成功拔除气切套管的相关因素分析[J]. 中国康复医学杂志,2023,38(9):1227-1232.
Li Q,Jiang HY,Zhou T,et al.Multivariate analysis of successful tracheostomy decannulation in patients with difficulty in decannulation[J]. Chin J Rehabil Med,2023,38(9):1227-1232.
[4] Trouillet JL,Collange O,Belafia F,et al.Tracheotomy in the intensive care unit:guidelines from a French expert panel:the French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine[J]. Anaesth Crit Care Pain Med,2018,37(3):281-294.
[5] 《成人气管切开拔管中国专家共识》编写组,中华医学会物理医学与康复学分会心肺康复学组,中国康复医学会重症康复专业委员会. 成人气管切开拔管中国专家共识(上)[J]. 中华物理医学与康复杂志,2023,45(6):481-487.
The Writing Group of Chinese Expert Consensus on Tracheotomy and Extubation in Adults,Cardiopulmonary Rehabilitation Group of Physical Medicine and Rehabilitation Division of Chinese Medical Association,Intensive Care Rehabilitation Professional Committee of Chinese Rehabilitation Medicine Association. Chinese expert consensus on tracheotomy extubation in adults(Ⅰ)[J]. Chin J Phys Med Rehabil,2023,45(6):481-487.
[6] 舒越,毕蒙蒙,张超,等. ICU患者人工气道气囊管理的最佳证据总结[J]. 中华护理杂志,2022,57(24):3038-3045.
Shu Y,Bi MM,Zhang C,et al.Summary of the best evidence of artificial airway endotracheal tube cuff management in ICU adult patients[J]. Chin J Nurs,2022,57(24):3038-3045.
[7] 《成人气管切开拔管中国专家共识》编写组,中华医学会物理医学与康复学分会心肺康复学组,中国康复医学会重症康复专业委员会. 成人气管切开拔管中国专家共识(下)[J]. 中华物理医学与康复杂志,2023,45(7):577-584.
Chinese Expert Consensus on Tracheotomy and Extubation in Adults Writing Group,Cardiopulmonary Rehabilitation Group of Physical Medicine and Rehabilitation Division CMACCCRC,Chinese Society of Rehabilitation Medicine. Chinese expert consensus on tracheotomy extubation in adults(Ⅱ)[J]. Chin J Phys Med Rehabil,2023,45(7):577-584.
