气管切开术的并发症(附213例病例分析)

本文报道了气管切开术各种并发症的发病率,并对术中或术后并发症的病的病因、发病机理、治疗和预防进行了讨论。     

气管切开与呼吸机机械通气抢救有机磷农药中毒致呼吸肌麻痹6例

目的：探讨气管切开与呼吸机机械通气抢救重度有机磷农药中毒（ＡＯＰＰ）致呼吸肌麻痹的疗效。方法：对６例重度ＡＯＰＰ致呼吸肌麻痹患者在综合治疗基础上，及时予气管切开，并使用全能呼吸机机械通气。结果：治愈５例，死亡１例。抢救成功率达８３．３％。结论：对重度ＡＯＰＰ患者及时行气管切开，并使用全能呼吸机机械通气，抢救效果良好。     

经皮扩张性气管切开术的临床应用

目的：探讨经皮扩张性气管切开术行气管切开及气道套管插入的方法与效果。方法：在内科ICU病房内，采用一步性扩张气管切开术，对35例患者进行气管切开，同时采用纤维支气管镜对其中l0例患者进行气道内检查。结果：按照操作规程，均完成了气管切开及气管套管的插入，平均操作时间为5．4min．所有患者在带管过程中及拔管后，未发现有气道狭窄的发生，无瘘管或瘘道形成，且创口愈合良好。结论：经皮扩张性气管切开术操作简便易行，值得临床推广使用。     

41例气管切开手术后护理体会

目的:总结气管切开术后护理体会.方法:探讨41例气管切开术后患者的心理护理、并发症的防范和护理要点.结果:2例死于各自原发病,39例患者在术后8～128天内顺利拔管.结论:规范的术后护理对保证气管切开术后效果起着至关重要的作用.     

Implementation of percutaneous dilation tracheotomy – value of preincisional ultrasonic examination?

BACKGROUND: In this observational study we have evaluated the implementation of percutaneous dilation tracheotomy (PDT), using the forceps dilation technique (Portex) in a multidisciplinary ICU. METHODS: We included a preincisional ultrasonic evaluation of the neck in order to visualise the isthmus glandula thyroidea and major vessels. The observational period comprised one year. PDT was performed in 28 patients. RESULTS: Implementation of PDT was uneventful. Duration of insertion was 10 min (4-40 min). Total time of tracheostomy was 8 days (1-65 days). In nine cases, the proximal end of the isthmus was overlying the space between the 1st and 2nd tracheal ring, which was considered the optimal insertion site. This resulted in seven cases of insertion between the cricoidea and the 1st tracheal ring and in two cases in a more distal insertion. Nineteen tracheotomies were performed in the interstice between the 1st and 2nd tracheal ring. In nine patients, major vessels were overlying the trachea. In none of the patients did this information result in an altered insertion site. Two cases of minor bleeding were observed; both stopped upon compression. In two patients the primary tube size (8.0) was too big and a smaller tube had to be inserted. In one patient the tube was maladapted to the stoma and had to be interchanged with an ordinary tracheostomial tube on the 5th day of tracheostomy. CONCLUSION: Based on the experience gathered in this study and information from the literature, we have abandoned the routine use of ultrasonic examination of the neck prior to PDT. In order to achieve and maintain routine, we suggest that the procedure is performed by a restricted number of doctors.     

气管切开术在胸腹联合伤中的诊治体会

目的:减少严重胸腹联合伤病人的并发症,提高临床治愈率.方法:严重胸腹联合伤的12例病人于伤后2～20h急诊行开腹手术,腹腔闭式引流术.结果:同时行气管切开术的8例病人治愈7例,死亡1例为合并严重颅脑损伤者.术后第2日行气管切开者2例因气道阻塞,窒息至植物状态.结论:对严重胸腹联合伤的病人,术后立即行气管切开术,有助于防止因气道阻塞而窒息,并发感染,甚至继发ARDS,放宽此类病人的气管切开指征,有助于术后气道内分泌物的清理,呼吸机的及时应用有利于提高治愈率.     

精密输液器的使用对高压氧治疗中气管切开插管患者气道湿化的影响

目的：探讨精密输液器的使用对高压氧治疗中气管切开插管患者气道湿化的影响。方法：76例气管切开术后患者均采用精密输液器进行气道湿化，观察其治疗前和治疗第1、3、5、10天的刺激性咳嗽、痰阻次数、吸痰量、吸痰次数等指标。结果：至治疗后10天，患者的刺激性咳嗽、痰阻次数、吸痰量、吸痰次数等指标均显著改善（P〈0.01），痰液粘稠度亦显著降低（P〈0.05）。结论：使用精密输液器能达到理想的湿化效果，降低了患者的高气道反应，减少了对气道的刺激，并且操作简单、安全可靠，值得临床推广应用。     

气管切开术后下呼吸道感染的原因分析及护理对策

目的探讨气管切开术后患者下呼吸道感染的相关因素,提出相应护理对策,以降低其发生率,提高护理质量。方法采取调查方法,对2010年1月-2013年1月入住重症医学科的95例气管切开术后患者进行观察。结果 42例并发下呼吸道感染,病原菌以G-杆菌为主（占72.0%）,其次G＋球菌（占17.9%）,真菌（占10.1%）及二重感染（占8.5%）也常见。其中铜绿假单孢菌为29.3%,鲍曼不动杆菌为17.2%,金黄色葡萄球菌为16.5%,肺炎克雷伯菌为13.7%,大肠埃希菌为10.8%,其它细菌占2.4%。结论采取有效的护理对策,可降低气管切开术后下呼吸道感染的发病率,减少院内感染发生。     

采用穿刺侧肢体外展120°体位对气切患者PICC置管的研究

目的探讨穿刺侧肢体外展120°体位对气管切开患者PICC置管的影响。方法将120例需行PICC穿刺的气管切开患者，随机分为试验组和对照组，各60例。对照组采用传统穿刺体位。试验组采用穿刺侧肢体外展120°体位。比较两组置管成功率、置管时间、患者舒适度、置管后并发症的差异。结果试验组置管成功率100％，平均置管时间28min，置管后并发症发生率3．3％。对照组置管成功率88．3％，平均置管时间40min，置管后并发症发生率26．4％，两组比较有显著性差异（P〈0．05）。术后舒适度评分，试验组为2．5分，对照组为2．8分，两组比较无显著性差异（P〉0．05）。结论对于气管切开患者行PICC置管，穿刺侧肢体外展120°较传统穿刺体位更加安全高效，减少了患者痛苦及因反复盲目调节导管而导致的感染发生，也简化了护士的操作流程，更重要的是增加了气管切开患者PICC置管的成功率，保证患者得到及时有效的治疗。