重度吸入性损伤气管切开的护理体会

目的总结重度吸入性损伤气管切开的护理措施和体会。方法对我院收治的38例重度吸入性损伤患者气管切开的护理措施进行回顾性分析。结果38例患者中31例抢救成功,顺利拔管,7例死亡,成功率81．6％。结论对重度吸入性损伤气管切开后行有效的气道湿化、及时地吸痰、能减少并发症的发生,缩短原发病治愈时间。     

严重吸入性损伤气管切开患者的心理护理

目的:总结分析吸入性损伤气管切开患者的心理特点,探讨有效的心理干预措施.方法:注意和了解吸人性损伤气管切开患者的思想情绪,有针对性地进行心理护理,利用一切手段与患者沟通,如语言沟通、视觉沟通、手势沟通等.结果:通过与患者及时地沟通,使其树立了战胜疾病的信心和生活的勇气,能积极配合治疗,缩短疗程,促进痊愈.结论:在严重吸人性损伤气管切开患者中,做好心理护理工作,对治疗能起到相辅相成的作用.     

吸入性损伤气管切开问题的临床讨论

目的：为了进一步探讨吸入性损伤病人的气管切开时机与指征。方法：回顾性总结分析了１９８１～１９９８年１７３例吸入性损伤的处理方法。他们中轻、中、重度吸入性损伤分别为９４．５３和２７例,行气管切开５７例。结果：全组死亡５６例,病死率与烧伤情有一定关系,但主要死罪仍为吸入性损伤程度,２４小时之内行气管切开病死率偏低。结论：中、重度吸入性损伤宜尽早衽气管切开治疗,并有预防意义。     

烧伤合并吸入性损伤行气管切开术护理体会

烧伤合并吸入性损伤行气管切开术护理体会武警天津总队医院烧伤科李建芳朱新英杨丽（天津３００１６２）关键词烧伤合并吸入性损伤气管切开护理烧伤合并吸入性损伤行气管切开术后,由于创面细菌的污染和空气直接通过气管套管进入下呼吸道,失去了上呼吸道加温湿化及屏障作...     

吸入性损伤病人气管切开术后的信息交流与护理

为预防喉头水肿和气管粘膜脱落引起的窒息,临床对中度以上的吸人性损伤病人常采用气管切开以保持呼吸道通畅。由于气管切开后病人不能正常发音,从而导致与周围人群的语言障碍。我们对28例中度以上的吸入性损伤气管切开的患者采取术前谈话约定、术后固定标志物和肢体语言的应用等护患交流技巧,取得良好的临床效果。     

颅脑损伤患者气管切开的护理体会

颅脑损伤患者气管切开的护理体会廉春姬颅脑损伤患者常有不同程度的意识际份、咳嗽、吞咽功能减低．呼吸道分泌物不能主动排除．血液、脑打液及呕吐物可逆流人呼吸道．在神志迟钝和浅口述时，异物刺激喉头亦可引起喉痉挛，昏迷者下颌松弛．舌根下坠义可导致严重的呼吸道梗...     

烧伤伴吸入性损伤行气管切开的抢救资料分析

 目的 探讨烧伤合并吸入性损伤患者行气管切开术的时机及并发症的预防和处理.方法 对96例烧伤合并吸入性损伤病患行气管切开观察其预后.结果 96例气管切开成功抢救91例,死亡5例,发生并发症18例(18.75%).烧伤后6 h内气管切开并发症发生率(14.3%)明显低于其他时间段,按照烧伤程度由重到轻的并发症发生率分别为25.0%、17.3%、15.0%.结论 头颈部烧伤合并吸入性损伤患者尽早行气管切开是抢救生命的重要而有效的手段.     

吸入性损伤的临床分析

目的：回顾我科1996年—2001年6年中收治1058例烧伤患者，分析吸入性损伤病例，总结临床治疗的经验。方法：采用统计学的方法，将病例按烧伤面积分成五个组别，对吸入性损伤的发生率、病死率与烧伤面积的关系分别进行分析。结果：吸入性损伤的发生率随烧伤面积的增大而上升，吸入性损伤的病死率改变与烧伤面积的变化不明显，烧伤合并吸入性损伤的病死率明显高于单纯皮肤烧伤患者的病死率，各烧伤面积组病死率随烧伤面积的增加而上升。结论：近年来我科吸入性损伤的救治水平有了明显的提高，通过伤后吸入高浓度的氧甚至纯氧；预防性气管切死伤后早期进行小量反复的气道灌洗；早期应用带湿化的PEEP机械性通气；调整休克期补液量和防治感染等治疗，使吸入性损伤的病死率大幅度降低。     

重型颅脑损伤气管切开68例护理体会

重型颅脑损伤患者行气管切开置管后并发肺部感染是死亡的重要原因之一。对此类患者进行科学有效的护理是康复成功的关键。现将我院2004～2006年收治的68例重型颅喃伤行气管切开患者护理体会报告如下。     

多人同时烧伤合并吸入性损伤的救治及护理

目的：总结多人同时烧伤救治的经验及护理。方法：对多人同时烧伤的休克期处理以及抢救组织工作进行回顾性总结。结果：本组4例病人全部治愈。结论：预见性护理可有效避免气道阻塞等危险的发生，为抢救病人生命赢得时间。救治多人同时烧伤只要组织工作、治疗方法和护理措施得当，可以取得满意的效果。     

气管切开术后气道出血的原因及护理对策

目的:分析气管切开术后气道出血原因,提出相应护理对策.方法:分析25例气管切开术后气道出血原因,主要有吸痰管选择不当、气道湿化不够、吸痰技术不熟练、病人躁动、术中止血不完善、切口感染、气管内壁糜烂或溃疡等,针对不同出血原因进行处理取得明显效果.结果:治愈15例,好转7例,非气道出血死亡3例.结论:气道出血的病人其出原因有其共性和个性,只有认真分析,采取相应的护理对策,才能达到理想的效果.     

大鼠烟雾吸入伤后肺泡内表面活性物质亚型的变化及意义

目的 探讨烟雾吸入后肺泡内表而活性物质(PS)亚型分布的变化和可能机制,以及其与PS活性抑制的关系.方法 采用大鼠烟雾吸入伤模型,分别检测了正常对照组及致伤2、6、12、24 h大鼠的动脉血气、肺水量、支气管肺泡灌洗液(BALF)表面张力特性、BALF总磷脂(TPL)、总蛋白(TP)、白蛋白(Alb)含昔及α1抗胰蛋白酶(α1-AT)活性、肺泡腔内PS亚型超微结构.结果 大鼠烟雾吸入伤后出现急性呼吸衰竭和严重肺水肿;BALF最小表面张力(STmin)进行性升高;BALF中TPL、TP、Alb及α1-AT增加,且STmin与α1-AT/TP、α1-AT/Alb比值的变化相关显著;伤后早期肺泡腔内PS板层体和囊泡聚集,管髓体破坏;后期大量囊泡聚集,板层体少,管髓体几乎缺失.结论 烟雾吸入伤后肺泡腔内PS亚型分布及转化异常是引起PS活性抑制的主要原因之一,α1-AT与血浆蛋白比例失衡可能起重要作用.     

Acute and repeated inhalation lung injury by 3-methoxybutyl chloroformate in rats: CT-pathologic correlation

OBJECTIVES: To investigate the acute and repeated pulmonary damage in Sprague-Dawley rats caused by the inhalation of 3-methoxybutyl chloroformate (3-MBCF) using computed tomography (CT), and to correlate these results with those obtained from a pathological study. METHODS: Sixty, 7-week-old rats were exposed to 3-MBCF vapor via inhalation (6 h/day) for 1 day (N=20), 3 days (N=20), and 28 days (5 days/week) (N=20) using whole body exposure chambers at a concentration of 0 (control), 3, 6 and 12 ppm. CT examinations including densitometry and histopathologic studies were carried out. For the follow-up study, the rats exposed for 3 days were scanned using CT and their pathology was examined at 7, 14, and 28 days. RESULTS: There was a significant decrease in the parenchymal density in the groups exposed to the 3-MBCF vapors for 1 day at 3 ppm (p=0.022) or 6 ppm (p=0.010), compared with the control. The parenchymal density of the rats exposed to 12 ppm was significantly higher. The pathological findings in this period, the grades of vascular congestion, tracheobronchial exfoliation, and alveolar rupture were significant. In the groups exposed for 3 days, there was a large decrease in the parenchymal density with increasing dose (control: -675.48+/-32.82 HU, 3 ppm: -720.65+/-34.21 HU, 6 ppm: -756.41+/-41.68 HU, 12 ppm: -812.56+/-53.48 HU) (p=0.000). There were significant density differences between each dose in the groups exposed for 28 days (p=0.000). The CT findings include an irregular lung surface, areas of multifocal, wedge-shaped increased density, a heterogeneous lung density, bronchial dilatation, and axial peribronchovascular bundle thickening. The histopathology examination revealed the development of alveolar interstitial thickening and vasculitis, and an aggravation of the mainstem bronchial exudates and bronchial inflammation. The alveolar wall ruptures and bronchial dilatation became severe during this period. On the follow-up study, the groups exposed for 3 days showed diffusely increased parenchymal density on the 7 days study, but the lung densities were lower at 14 and 28 days than at 3 days. In the rats exposed to lowest concentration, the pulmonary parenchymal density and pathologic findings rapidly returned to normal within 1 week. CONCLUSIONS: Decreased parenchymal density of the lung was a common CT finding in acute and repeated inhalation injury. The air accumulation is believed to be the results of tracheolaryngeal inflammatory edema, bronchial dilatation, and alveolar rupture from the early period.     

烟雾吸入伤后肺表面活性物质蛋白A含量的动态变化及意义

目的探讨烟雾吸入伤后肺表面活性物质蛋白Ａ（ＳＰ－Ａ）含量的变化、可能机理及其与肺表面活性物质（ＰＳ）活性抑制和肺功能损害的关系。方法采用大鼠烟雾吸入伤模型，分别检测正常对照及致伤２ｈ、６ｈ、１２ｈ和２４ｈ动物的动脉血气，肺水量，静态肺顺应性（Ｃｓｔ），支气管肺泡灌洗液（ＢＡＬＦ）表面张力特性，ＢＡＬＦ中ＳＰ－Ａ、丙二醛（ＭＤＡ）、总蛋白（ＴＰ）含量及弹性蛋白酶（Ｅｌａ）活性。结果动物伤后出现急性呼吸衰竭和肺水肿，Ｃｓｔ显著降低；ＢＡＬＦ的最小表面张力（ＳＴｍｉｎ）升高，滞后环面积下降；ＢＡＬＦ中ＳＰ－Ａ、ＭＤＡ、ＴＰ含量及Ｅｌａ活性明显升高，但ＳＰＡ－Ａ的相对含量（％ＴＰ）降低，且与Ｅｌａ、Ｃｓｔ和ＳＴｍｉｎ的变化相关显著。结论烟雾吸入伤早期ＳＰ－Ａ相对含量减少，可能是导致肺表面活性物质活性抑制及肺功能障碍的主要原因之一。氧化及Ｅｌａ可能是引起ＳＰ－Ａ含量和（或）功能异常的重要因素。     

吸入性损伤对小鼠肺组织细胞凋亡的影响

目的探讨细胞凋亡、促凋亡基因和凋亡抑制基因在吸入性损伤发生的作用及意义。方法以小鼠烟雾吸入性损伤为模型，应用RT—PCR和TUNEL技术，观察其损伤后肺组织中Bcl-2和Bax基因mRNA表达及细胞凋亡的变化。结果小鼠烟雾吸入性损伤后肺组织Bcl-2和Bax的表达增加，细胞凋亡指数升高，与对照组相比，差异有非常显著性（P〈0．01）。结论提示细胞凋亡可能参与了吸入性损伤肺组织的病理形成过程。     

电击伤患者临床观察及护理

目的：以再生医学理论为指导，探讨对电击伤患者的护理。方法：本组23例患者均采用湿润暴露疗法，外涂湿润烧伤膏，结合全身营养支持并辅以抗生素及高压氧治疗。结果：23例患者愈合时间最短10天，最长116天。结论：电击伤可造成机体深部组织损伤，针对病因进行治疗护理是患者痊愈的保证。     

Detection of acute inhalation injury in fire victims by means of technetium-99m DTPA radioaerosol inhalation lung scintigraphy

Mortality and morbidity in fire victims are largely a function of injury due to heat and smoke. While the degree and area of burn together constitute a reliable numerical measure of cutaneous injury due to heat, as yet no satisfactory measure of inhalation injury has been developed. In this study, we employed technetium-99m diethylene triamine penta-acetic acid (DTPA) radioaerosol lung scintigraphy (inhalation scan) to evaluate acute inhalation injury in fire victims. Ten normal controls and 17 survivors from a fire accident were enrolled in the study. All patients suffered from respiratory symptoms (dyspnoea and/or cough with sputum).^99mTc-DTPA aerosol inhalation lung scintigraphy was performed in all subjects, using a commercial lung aerosol delivery unit. The degree of lung damage was presented as the clearance rate (k; %/min) calculated from the time-activity curve over the right lungs. In addition, the distribution pattern of the radioactivity in the lungs was evaluated and classified into two groups: homogeneous distribution and inhomogeneous distribution. A plain chest radiograph (CxR) and pulmonary function test (PFT) were performed in the same group of patients. The results showed that 6/17 (35.3%) opatients had inhomogeneous distribution of radioactivity in their inhalation scans, and 11/17 (64,7%) had homogeneous scans. Five of the six patients with inhomogeneous scans were admitted for further management, and all patients with homogeneous scans were discharged from the emergency department and needed no further intensive care. The clearance rates of the right lung were 0.73%±0.13%/min from normal controls and 1.54%±0.58%/min for fire victims. The difference was significant, with aP value of less than 0.01. Using a cut-off value of 0.9%/min (all normal subjects were below 0.9%/min) 14 (82.4%) patients had abnormal clearance rates of^99mTc-DTPA from the lung. In contrast, only three (17.6%) patients had abnormal CxR and three (17.6%) had abnormal PFTs. We conclude that (1) conventional CxR and PFT are not good modalities for evaluating inhalation injury in fire victims because of their low sensitivity, and (2)^99mTc-DTPA radioaerosol inhalation scintigraphy can provide an objective evaluation of inhalation injury during a fire accident and may be useful in therapeutic decision-making and disease monitoring.     

经皮扩张气管套管导入术在脑出血患者中的临床应用

目的总结经皮扩张气管套管导入术在脑出血患者急症抢救中的应用经验。方法对44例需行气管切开的脑出血患者分别行经皮扩张气管套管导入术(PDT组)及传统开放式气管切开术(OT组),对两组的手术时间、切口长度及愈合时间进行比较。结果 PDT组手术时间[(9.5±3.2)min]、切口长度[(1.5±0.3)cm]、愈合时间[(5.3±1.3)d],均优于OT组手术时间[(26.5±5.6)min]、切口长度[(3.8±1.7)cm]、愈合时间[(8.5±1.9)d];组间差异均有统计学意义(P<0.05)。结论经皮扩张气管套管导入术能更加简便、快捷、安全的通畅气道,在脑出血合并上呼吸道梗阻、通气障碍患者中具有较好的应用价值。