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1.
在危重病人的救治工作中,吸痰是有效维护人工气道通畅、保证足够的通气和充分气体交换的关键措施。为了提高吸痰效率、减少吸痰引起的并发症,目前临床上多采用密闭式气管内吸痰术(closed endotrached suctioning,CS),现将其在ICU中的应用及管理综述如下。1CS应用方法将密闭式吸痰系统三通分别与患者人工气道(气管插管或气管切开)、呼吸机Y型管、负压吸引装置相连,形成密闭吸引系统。气道湿化接头接注射器推注湿化液或用输液器滴入湿化液。吸痰时左手持吸痰管与负压吸引连接处,拇指或食指控制吸引阀,右手接吸痰管沿气管插管插入所需深度,…  相似文献   

2.
人工气道吸痰导管插入深度的临床研究   总被引:9,自引:0,他引:9  
高峰 《齐鲁护理杂志》2006,12(3):209-209
目的:探讨人工气道患者吸痰时吸痰管插入的有效深度。方法:将90例人工气道患者随机分成A组(浅吸痰)30例,B组(深吸痰)30例,C组(吸引管插入的深度为气管插管或气管切开导管的长度再延长1 cm)30例,观察3种方法吸痰的效果。结果:A、B两组患者痰痂堵塞、黏膜损伤出血、肺部感染、刺激性咳嗽等方面无显著性差异(P>0.05),与C组相比有显著性差异(P<0.01)。结论:人工气道患者吸痰,吸痰导管插入深度按厘米加刻度标记,以气管插管或切开导管长度再延长1 cm为宜。  相似文献   

3.
刘晓荣 《全科护理》2013,11(4):371-373
综述机械通气人工气道内吸痰的护理进展,包括吸痰管的选择、吸痰时机的判断、吸痰方式的选择、吸痰压力和时间、吸痰管插入深度以及声门下吸引、气道湿化。  相似文献   

4.
目的 比较2种人工气道湿化吸痰方法的效果.方法 将50例建立人工气道的成人患者随机分成两组,人工气道湿化后常规电动吸引器吸痰为A组,即参照组;人工气道湿化后先呼吸气囊辅助呼吸1~3 min再电动吸引器吸痰为B组,即实验组.结果 湿化后呼吸气囊辅助吸痰(5.26±1.74)次/d与常规吸痰(13.37±4.19)次/d相比较,可减少吸痰次数而降低对气道黏膜的损伤程度,并降低患者肺部感染率,两组之间差异有统计学意义(P<0.05).结论 气道湿化后呼吸气囊辅助吸痰效果满意,且对气道黏膜的损伤程度小.  相似文献   

5.
减少新生儿气道内吸痰并发症的探讨   总被引:11,自引:0,他引:11  
目的改进气道吸痰法以减少并发症的发生。方法将NICU气管插管行呼吸机治疗的新生儿肺炎患儿90例随机分为3组,每组30例。对照组:定时吸痰,常规气道内注入生理盐水稀释痰液,气道冲洗或吸痰前后给予气囊加压给氧,吸痰管送入至遇到抵抗或稍退后,再开始边吸引边转动吸痰管边向外撤出;实验组A在对照组的基础上改进:按需吸痰,常规气道内不注入生理盐水,在吸痰前后5min适当调高呼吸机氧浓度(10%~20%);实验组B在实验组A的基础上再改进:边吸引边转动吸痰管向内插,达到预定深度后迅速撤出。结果实验组B较对照组及实验组A在气道黏膜受损出血方面有显著改善(P<0.01)。实验组B与对照组在所产生的并发症在痰阻、吸痰时经皮测血氧饱和度(SPO2)下降至80%以下方面比较差异有显著性(P<0.01)。结论采用适时准确吸痰及必要时气道内注入生理盐水稀释痰液再吸痰,并在插入吸痰管时采用边吸引边转动吸痰管边向气管插管内送,达到所需深度后迅速撤出的吸痰法时能明显减少气道内吸痰时的并发症。  相似文献   

6.
目的:探讨人工气道患者有效、安全的吸痰深度。方法:将60例肺部感染、气道分泌物量在中量以上、建立人工气道行机械通气的患者随机分成A、B、C三组各20例,A组为浅吸痰,即将吸痰管插入的深度小于气管插管或气管套管的长度;B组为深吸痰,即将吸痰导管插入气管直至遇到阻力,再上提1~2 cm;C组吸痰管插入的深度为气管插管或气管切开套管长度再延长1 cm。观察比较三组吸痰后吸痰有效性指标及安全性指标。结果:B、C组吸痰后有效性指标与A组相比较差异具有统计学意义(P<0.05);B组与A、C组吸痰后安全性指标相比较差异具有统计学意义(P<0.05)。结论:将吸痰管插入至气管插管或气管切开套管长度再延长1 cm处行吸痰的方式不仅可以达到深吸痰方式的效果,而且其引起的并发症相对较少,对气道黏膜的损伤小,是较浅吸痰与深吸痰更合理、更可取的吸痰深度。  相似文献   

7.
减少新生儿气道内吸痰并发症的探讨   总被引:12,自引:0,他引:12  
目的 改进气道吸痰法以减少并发症的发生。方法 将NICU气管插管行呼吸机治疗的新生儿肺炎息儿90例随机分为3组,每组30例。对照组:定时吸痰,常规气道内注入生理盐水稀释痰液,气道冲洗或吸痰前后给予气囊加压给氧,吸痰管送入至遇到抵抗或稍退后,再开始边吸引边转动吸痰管边向外撤出;实验组A在对照组的基础上改进:按需吸痰,常规气道内不注入生理盐水,在吸痰前后5min适当调高呼吸机氧浓度(10%~20%);实验组B在实验组A的基础上再改进:边吸引边转动吸痰管向内插,达到预定深度后迅速撤出。结果 实验组B较对照组及实验组A在气道黏膜受损出血方面有显著改善(P〈0.01)。实验组B与对照组在所产生的并发症在痰阻、吸痰时经皮测血氧饱和度(SPO2)下降至80%以下方面比较差异有显著性(P〈0.01)。结论 采用适时准确吸痰及必要时气道内注入生理盐水稀释痰液再吸痰,并在插入吸痰管时采用边吸引边转动吸痰管边向气管插管内送,达到所需深度后迅速撤出的吸痰法时能明显减少气道内吸痰时的并发症。  相似文献   

8.
经鼻气管插管吸痰方法的临床研究   总被引:14,自引:0,他引:14  
目的探讨吸痰方法对经鼻气管插管气道护理的影响,提高经鼻气管插管气道护理质量。方法对120例经鼻气管插管病人根据吸痰方法随机分组为规范组58例和常规组62例,规范组要求:控制吸痰管插入深度,随吸痰管插入深度调节负压,适时吸痰,加强气道湿化,吸痰管金霉素眼膏润滑,加强口腔护理等;常规组按临床一般吸痰方法吸痰。比较观察两组病人痰液性状、痰量、痰痂、痰细菌培养、肺部感染等变化。结果常规吸痰组病人黄色粘稠痰者占69.35%,痰量〉80ml占70.97%,痰痂形成占61.29%.细菌培养阳性占64.52%.肺部感染占51.61%.而规范组病人分别为31.03%,25.86%,5.17%,20.69%,22.41%,P〈0.005。结论规范吸痰,可有效改善痰液性状、减少痰量及痰痂、减少肺部感染发生。  相似文献   

9.
陈丹 《当代护士》2014,(8):11-13
综述了机械通气患儿人工气道内吸痰的护理进展,包括吸痰时机的判断、气道湿化、吸痰管的选择、吸痰压力和时间、吸痰方式的选择、吸痰管插入深度以及操作方法和吸痰后的护理,认为正确的吸痰技术是提高护理质量的重要技能,有利于提高抢救成功率。  相似文献   

10.
外科护理     
012490严重烧伤合并吸人性损伤的呼吸道管理/曹淑琴刀解放军护理杂志一2000,17(5)一44一45 1.保持呼吸道通畅,及时用棉签清除鼻腔分泌物。2.采用鼻导管低流量吸氧,如患者出现低氧血症,而PaCq正常时,给中等浓度氧,合并呼吸衰竭者行气管插管或气管切开。3.重视呼吸功能的训练,指导患者深呼吸,并鼓励患者自主咳嗽。4.气管切开时,要掌握正确的吸痰方法,吸痰管的直径应小于气管内套管内径的1/2,由浅入深徐徐插入,待吸管达到一定深度后向上边吸边提;做好气道湿化护理,对用呼吸机辅助呼吸的患者,除进行气道湿化、给氧外,重点注意观察患者生命体征…  相似文献   

11.
The authors report the case of an elder woman involved in a motor vehicle collision (MVC) requiring emergent intubation using the technique of retrograde intubation (RI). Since RI is a blind technique, potential complications arising from its use are numerous and may result in increased morbidity and mortality. Such was the case of this RI that involved incorrect placement of the endotracheal tube (ETT), resulting in suboptimal ventilation and increased morbidity. Additionally, this case illustrates how the failure to detect this error in multiple settings (ambulance, helicopter, emergency department) led to unnecessary and potentially deleterious procedures and significant delay in providing the basics of trauma care, oxygenation and ventilation. Although theoretical complications of RI have been addressed in the past, there have been very few published reports of actual complications. The emergency physician must be aware of difficult airways, options available to establish alternative airways, and methods to confirm appropriate placement of the ETT. The authors also discuss the indications, procedures, and complications involved in performing an RI.  相似文献   

12.
13.
OBJECTIVE: Determining the correct position of endotracheal tubes in critically ill patients may be complicated by external factors such as noise, body habitus, and the need for ongoing resuscitation. Multiple detection techniques have been developed to determine the correct endotracheal tube position, recently including the use of sonography to evaluate lung expansion and diaphragmatic excursion. These techniques have also been applied to diagnosis of right endobronchial main stem intubation, which may be confused with a unilateral pneumothorax in some cases. METHODS: We describe the sonographic findings in a case series of endobronchial main stem intubations and obstruction, highlighting the utility of this sonographic application. Previous literature and future applications are discussed. RESULTS: Sonographic detection of the sliding lung sign, the lung pulse, and diaphragmatic excursion can accurately detect main stem bronchial intubation as well as bronchial obstruction. CONCLUSIONS: Clinical use of lung sonography may decrease the need for chest radiography and may allow more rapid diagnosis of main stem intubation and bronchial obstruction.  相似文献   

14.
Objective : To determine the optimal initial depth of tube placement in nasotracheal intubation (NTI) of adult patients, measured at the naris, prior to obtaining a chest radiograph (CXR).
Methods : Part 1: A prospective, observational study was performed to compare the initial depth of NTI, measured at the naris, with the observed height of the endotracheal tube (ETT) tip above the carina on the initial CXR. Optimal depths were predicted by gender. Part 2: Results from Part 1 were prospectively validated by measuring the frequency of adequate placement when ETTs were placed to this depth. ETT placement was considered adequate if the tip was at least 2 cm above the carina and below the larynx on the CXR.
Results : Part 1: The mean depth measured at the naris was 27.5 ± 1.5 cm in women ( n = 50) and 27.8 ± 1.0 cm in men ( n = 74). The mean distance of the tip of the ETT to the carina was 3.9 ± 2.7 cm in women and 6.4 ± 2.2 cm in men. Initial tube position was adequate in 39 (78%) of the women and 72 (97%) of the men. It was determined that if a depth of 26 cm had been used in the women and 28 cm in the men, 45 (90%) of the women and 70 (95%) of the men would have had adequate tube placement, resulting in statistically significant improvement of placement in the women (p < 0.05; McNemar & chi2)- Part 2: These calculated depths (26 and 28 cm) were then prospectively applied in 26 women and 52 men. Twenty-five (96%) of 26 women and 51 (98%) of 52 men had adequate placement, with a mean height above the carina of 4.5 ±1.4 cm in women and 5.6 ± 1.8 cm in men.
Conclusion : Initial placement of NTI at 26 cm in women and 28 cm in men, measured at the naris, resulted in adequate initial placement for most adult patients.  相似文献   

15.
Objective. Out-of-hospital rescuers often use drug-assisted intubation (DAI) to facilitate endotracheal intubation (ETI) of nonarrest patients. However, the relationship between the ablation of individual protective airway reflexes andresulting DAI success has not been defined. We sought to describe the relationship between the depression or ablation of protective airway reflexes andDAI success. Methods. We analyzed data from a prospective multicenter trial. Rescuers from 42 emergency medical services systems reported clinical ETI data using standardized reporting forms. We analyzed the subset receiving sedative and/or neuromuscular blocking agents to facilitate ETI. We defined successful ETI as intratracheal placement of the endotracheal tube on the last ETI attempt. Rescuers reported the presence andablation of six protective airway reflexes, including the presence of a gag, trismus, inadequate relaxation, combativeness, laryngospasm, andseizure/myoclonus. We examined the relationship between protective reflex ablation andDAI success. Results. Of 1,953 ETIs, 208 (10.7%) used DAI (128 sedation only, 80 neuromuscular blocking agents/rapid sequence intubation). Successful DAI was associated with ablation of gag reflex (odds ratio [OR], 12.7; 95% confidence interval [CI] 3.7 to 46.2), clenched jaw/trismus (OR, 54.4; 95% CI, 11.1 to 292.4), inadequate relaxation (OR, 16.3; 95% CI, 3.7 to 96.4), andcombativeness (OR, 10.2; 95% CI, 1.5 to 76.8). Successful DAI was associated with the total number of ablated protective reflexes (p < 0.001). Conclusions. The ablation of selected andthe total number of protective airway reflexes was associated with DAI success. Successful ablation of protective airway reflexes should be considered when attempting to characterize DAI performance or the effectiveness of specific drug facilitation regimens.  相似文献   

16.

Background

Few studies have evaluated the impact of the upright position on the success of oral-tracheal intubation. Yet, for patients with airway difficulties (i.e, active intraoral bleeding or morbidly obese), the upright position may both benefit the patient and facilitate intubation.

Objectives

We compared the success rates of subjects performing standard intubation to a modified version of the sitting face-to-face oral-tracheal intubation technique on a simulation model. We also reviewed the possible advantages and limitations of the sitting face-to-face intubation technique.

Methods

Volunteer medical and paramedical students were given instruction, then tested, performing in random order both standard oral-tracheal and two-person sitting face-to-face oral-tracheal intubation on full-bodied mannequins. Observers reviewed video recordings, noting the number of successful intubations and the time to completion of each procedure at 15, 20, and 30 s.

Results

All of the sitting face-to-face intubations were successful, 53/53 (100%, 95% confidence interval [CI] 93–100%); whereas of the 53 subjects who performed standard intubation, 48 were successful (91%, 95% CI 80–96%). The difference between successful intubations using the standard vs. sitting face-to-face technique was 9% (95% CI 1.3–9.4%, p = 0.025). At times 15 and 20 s, medical student subjects who successfully performed both techniques were less successful at completing the procedure when performing the standard technique as compared to the sitting face-to-face technique (p = 0.016). A post-procedural survey found that the majority of subjects preferred the sitting technique.

Conclusion

Subjects were significantly more successful at performing and preferred the sitting face-to-face intubation when compared to standard intubation.  相似文献   

17.
Objective: To evaluate the success rate, intubation time, and complication rate of transillumination–guided intubation following two hours of instruction in the use of the Trachlight (TL) device.
Methods: A prospective, randomized crossover laboratory trial was conducted at an emergency medical service training site with 30 nonpaid volunteer paramedic students, one month prior to their graduation. The students were instructed in the use of the TL in a standardized curriculum consisting of didactic, video, and demonstration sessions. Each student was required to successfully intubate a training manikin with the TL five times. Approximately three weeks later, the students were asked to intubate the manikin 20 times, alternating between direct laryngoscopy (DL) and TL.
Results: The success rates were 94% for DL and 63% for TL (p < 0.0001). The mean intubation times were 14.6 seconds for DL and 16.8 seconds for TL (p < 0.001). The incidences of trauma were 7.3% for DL and 1.4% for TL (p < 0.001).
Conclusion: A two–hour training session, including five successful light–guided intubations using the TL, was inadequate for producing acceptable success rates during manikin intubations by paramedic students. While TL intubation intervals were shorter when successful, the 2.2–second difference was not clinically meaningful. The incidence of trauma in our manikin model during TL intubations was significantly lower than that with DL.  相似文献   

18.

Background

Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients.

Objective

To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort.

Methods

This was a retrospective analysis using a large air medical airway registry using data from 160 bases over a 1-year period. Standard test characteristics (sensitivity, specificity, positive predictive value, negative predictive value [NPV]) for the HEAVEN criteria were calculated for overall intubation success, first-attempt success, and first-attempt success without desaturation. In addition, multivariable logistic regression was used to quantify the independent association between each of the HEAVEN criteria, as well as the total number of criteria present and intubation success after adjusting for age, gender, and clinical category (burn, medical, trauma, nontraumatic shock).

Results

A total of 2419 patients undergoing air medical RSI were included. Excellent NPV was observed (97% for each of the HEAVEN criteria except “Exsanguination,” which had an NPV of 87% but specificity of 99%). First-attempt success was lower for each of the HEAVEN criteria, with an inverse relationship observed between total HEAVEN criteria and intubation success (first-attempt success with no criteria = 94% and with 5 + criteria = 43%). Multivariable logistic regression revealed independent associations between each of the HEAVEN criteria, as well as total number of criteria and intubation success.

Conclusions

The HEAVEN criteria seem to be a useful tool to predict difficult airways in emergency RSI.  相似文献   

19.
气管内插管和置喉罩应激反应的比较   总被引:17,自引:0,他引:17  
目的 比较在麻醉诱导后气管内插管和置喉罩对病人的心血管反应和肾素—血管紧张素浓度的变化。方法 选择无心血管疾病 ,ASAI~II级 ,择期全麻手术患者40例 ,按投币法随机分成两组—气管内插管组(T组)和置喉罩组(L组) ,每组20例。气管内插管用喉镜明视插入法 ,喉罩按顺行盲探置入口底。全部病人均于诱导前 (t0)、气管内插管或置喉罩后即刻(t1)、1min(t2)、3min(t3)、5min(t4)测SBP、SDP、HR以及经颈内静脉采血标本2ML。血标本用放射免疫法测血管紧张素II(ATII)浓度、血管紧张素I(ATI)浓度时间变化率。结果 麻醉诱导后SBP、SDP、HR均下降(p<0.05) ,插管或置喉罩后即刻与1min两组比较有显著性意义 ,T组高于L组(p<0.05)。插管或置喉罩后ATII、ATI变化两组比较差别有显著性意义(p<0.05) ,且T组高于L组。结论 置喉罩对病人的应激反应小  相似文献   

20.
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