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1、,气 管 切 开 患 者 的 护 理 The gas tube is cut open the patient care,四川大学华西医院：刘虹运 West China Hospital of Sichuan University:Yang Li 2013.2.18 February 18,2013,（一）术后护理(a)the postoperative nursing,1、将患者安置于安静、清洁、空气新 1,patients will be placed in the quiet,clean,fresh air in the wards,鲜的病室内，室温保持在21，at room tempe
2、rature maintained at 21,humidity was maintained at 60%,湿度保持在60%，气管套口覆盖2-4层温湿tracheal sleeve opening cover the temperature of 2-4纱布，室内经常洒水，或应用湿器，定时wet gauze,indoor regular watering,or the application of humidifier,以紫外线消毒室内空气。timed to ultraviolet disinfection of indoor air.,2、手术之初患者一般取侧卧位，以利In 2,opera
3、tion at the beginning of the general lateral decubitus position,in order于气管内分泌物排出。to facilitate endotracheal secretions.但要经常转动体位，防止褥疮并使肺各部分But to the regular rotation position,preventing bedsore and the lung of each part of呼吸运动不致停滞。respiratory movement not stagnation.,3、备齐急救药品和物品，某些物品应置床头。3,prepare
4、first-aid medicines and articles,some items should be placed.同号气管套管，气管扩张器，外科手术剪，The same number of tracheal cannula,tracheal dilator,surgical operation scissors,止血钳，换药用具与敷料，生理盐水和饱和重碳酸钠液，forceps,dressing appliances and dressing,saline water and saturated sodium bicarbonate solution,导尿包、吸引器，氧化气筒，呼吸机，u
5、rethral catheterization bag,suction pump,oxidation,ventilator,手电筒等都应备齐，并妥为存放，以备急需。flashlight should prepare,and properly stored,for a rainy day.,4、谨防气管导管引起阻塞：阻塞原因一是气囊滑脱堵塞，4,beware of the tracheal catheter obstructive:obstruction is a blockage airbag spondylolisthesis,二是分泌物粘结成痂阻塞，如突然发生呼吸困难、发绀、病人烦躁不安，
6、two is bonded into callus secretion obstruction,such as sudden onset of dyspnea,cyanosis,patient restlessness,应立即将套管气囊一起取出检查。should immediately check out with the sleeve bag.为预防气囊滑脱，应注意将气囊扎牢固，将线头引出气管切开伤口处，In order to prevent the air detachment,attention should be paid to the balloon tied firmly,will
7、 head out tracheotomy wound,并经常牵扯检查是否牢固，及时清除结痂。and often involve check whether the firm,the timely removal of incrustation.另外，在更换导管清洗消毒时，防止将棉球纱条遗留在导管内。In addition,in replacement of the cleaning and disinfection of the conduit,prevent cotton gauze left in the pipe.,5、及时吸痰：气管切开的病人，咳嗽排痰困难，5,suction tim
8、e:the patients tracheotomy,cough and expectoration difficulties,应随时清除气道中的痰液，吸痰时要严格遵守操作规程，should be kept clear of airway sputum,sputum aspiration to strictly abide by the rules,注意无菌观察。pay attention to aseptic observation.,6、充分湿化：气管切开的病人失去湿化功能，容易产生气道阻塞、肺不张6,adequates humidification:patient tracheotomy
9、 lose humidification function,easy to produce airway obstruction,和继发性感染等并发症pulmonary atelectasis and secondary complications such as infection.常采用下列方法湿化：Often used the following methods:（1）间歇湿化，生理盐水500ml加庆大霉素12万单位，每次吸痰后缓慢注入气管2-5ml，(1)intermittent humidification humidification,physiological saline 50
10、0ml plus gentamicin 120000 units,each time after endotracheal suction slowly into the trachea 2-5ml,每日总量约200ml，也可间断使用蒸气吸入器、雾化器做湿化；daily total about 200ml,can also be used intermittently vapor inhaler,nebulizer do humidification;（2）持续湿化法，以输液方式将湿化液通过头皮针缓慢滴入气管内，滴速控制在每分钟(2)continuous humidification meth
11、od,in order to infusion way humidification fluid through scalp needle drops slowly into the trachea,dropping speed control in every minute 4-6滴，每昼夜不少于200ml，湿化液中可根据需要加入抗生素或其他药物。4-6 drops,each day and night is not less than 200ml,the humidification bottle can be added to antibiotics or other drugs.,7、
12、预防局部感染：气管内套管每取出清洁消毒2-3次，7,to prevent local infection:endotracheal tubes each cleaned 2-3 times,外套管一般在手术后1周气管切口形成窦道之后可拔出更换消毒。the outer tube is generally in the 1 weeks after the operation the formation of sinus after incision of trachea can be pulled out to replace the disinfection.气管导管的纱布应保持清洁干燥，每日更
13、换。The tracheal tube gauze should be kept clean and dry,daily change.经常检查创口周围皮肤有无感染或湿疹。Always check the wound around with no infection or skin eczema.导管先用0.5%新洁尔灭浸泡，然后煮沸消毒，Catheter with 0.5%bromo-geraminum soak,and then boil disinfection,用清水冲洗后煮沸消毒即可使用。蛇形管用0.5%新洁尔灭浸泡，每日更换。rinse with water after boili
14、ng disinfection can be used.Serpentine pipe 0.5%Bromogeramine soaking,daily change.,8、关心体贴病人，给予精神安慰：。8,caring patients,to give spiritual comfort:患者经气管切开术后不能发音，可采用书面交谈或Patients with tracheotomy patients can not pronunciation,can use written conversation or gesture,prevention of patients with irritabl
15、e and I动作表示，will casingpulling,预防病人因急躁而自己将套管拔出，必要时可设法固定双手when necessary,try to fix the hands,（二）气管切开常见并发症(two)the common complications of tracheotomy1、脱管：常因固定不牢所致，脱管是非常紧急而严重的情况，1,off tube:often due to fixed due to poor,off tube is very urgent and serious condition,如不能及时处理将迅速发生窒息，停止呼吸。If not timely t
16、reatment will quickly asphyxia,stop breathing.,2、出血：可由气管切开时止血不彻底，或导管压迫、In 2,hemorrhage:by tracheotomy hemostatic not complete,or catheter,刺激、吸痰动作粗暴等损伤气管壁造成。stimulation,oppression of sputum suction of violent action and damage caused by tracheal wall.患者感胸骨柄处疼痛或痰中带血，一旦发生大出血时，Patients with sternal pain
17、 sense or sputum with blood,once the occurrence of bleeding,应立即进行气管插管压迫止血。should immediately endotracheal intubation compression hemostasis.,3、皮下气肿：为气管切开术比较多见的并发症，3,subcutaneous emphysema:tracheotomy is more complications,气肿部位多发生于颈部，偶可延及胸及头部。emphysema site occurred in the neck,chest and head can eve
18、n extend to.当发现皮下气肿时，可用甲紫在气肿边缘画以标记，以利观察进展情况。When the subcutaneous emphysema,available in emphysema edge is painted to mark the violet,to observe the progress of eli.,4、感染：亦为气管切开常见的并发症。4:also,infection is a common complication of incision of trachea.与室内空气消毒情况、吸痰操作的污染及原有病情均有关系。And air disinfection,ind
19、oor suction operation of pollution and the original condition of.,5、气管壁溃疡及穿孔：气管切开后套管选择不合适，5,tracheal wall ulcer and perforation:after incision of trachea cannula inappropriate choice,or the indwelling time longer,或置管时间较长，气囊未定时放气减压等原因均可导致。may airbag not timing release the pressure and other reasons.6
20、、声门下肉芽肿、瘢痕和狭窄：气管切开术的晚期并发症。6,subglottic granuloma,scar and stenosis:late complications of tracheotomy.,（三）吸痰时的注意事(three)note of the suction phlegm1、吸痰动作要轻柔迅速，减少对气管壁的损伤。1,sputum suction action should be gentle quickly,reduce the tracheal wall damage.一般选用硬度适中、表面光滑、内径相对大的12或14号橡胶或硅胶导管，General selection
21、of moderate hardness,smooth surface,large diameter relative 12 or 14 rubber or silicone catheter,或用专制的吸痰管，也可将导管前端较厚的盲端剪去，使之成向内凹之月or with autocratic sputum suction tube,the front end of the catheter can also be thicker牙形，blind to cut,再将两侧剪两个小孔，以减少头端吸痰时的负压，增加吸痰面积。make it into an inward concave of cres
22、cent,then cut on both sides of the two hole,to reduce the head end suction pressure the increase in sputum,sputum suction area.如患者感胸骨柄处疼痛及痰中带血，要警惕有出血的可能，Such as the sense of pain in patients with sternal manubrium and bloody sputum,to be alert to have bleeding may,一旦发生大出血，要立即实施气管插管，同时进行止血等抢救措施。upon
23、the occurrence of bleeding,to tracheal intubation immediately,at the same time,bleeding and other emergency measures.,2、吸痰时注意无菌操作，操作前洗手，导管严格消毒，2,suction notice aseptic manipulation,wash their hands before catheter operation,strict disinfection,一根导管只用一次，吸痰时坚持由内向外的原则，a catheter is used only once,from
24、inside to outside,先吸气管内分泌物，然后再吸鼻、口腔内分泌物。adhere to the principle of suction,suction tube first internal secretion,and then the nasal,oral secretions.,3、吸痰前应深呼吸3-5次，使用呼吸机者，需过度通气2-3分钟，3,sputum aspiration should be deep breath 3-5,ventilator,required hyperventilation 2-3 minutes,以提高肺泡内氧分压，然后快速、准确、轻柔地用吸痰
25、管抽吸分泌物。in order to improve the alveolar oxygen partial pressure,and rapid,accurate,gently suction tube suction secretions.禁忌将痰管上下提插。一次吸痰时间不超过15秒，尤其是呼吸衰竭患者，Taboo will sputum tube inserted under the.A suction time less than 15 seconds,especially in patients with respiratory failure,较长时间的负压吸引，可引起缺氧、呼吸困
26、难而窒息。the negative pressure for a long time,can cause hypoxia,dyspnea.如分泌物过多，一次吸不净，应再次行过度换气或深呼吸再吸引。Such as excessive secretion,a suction is not the net,should again hyperventilation or deep breathing to attract.,4、吸痰管一定要达到气管深度才能启动吸引器，或者启动吸引器时，4,sputum suction tube to tube depth to start the suction,o
27、r start the suction,用手将吸痰管与玻璃接头处反折，使之不漏气，the suction tube and glass joints reflexed by hand,so that does not leak,将吸痰管伸入气管达一定深度再放开吸痰。the suction tube into the trachea reaches a certain depth and then release the suction.5、吸引负压以6.7kpa（50mmHg）为宜。5,pressure 6.7kpa(50mmHg)is appropriate.6、在吸痰过程中病人常有咳嗽反射
28、，这有利于排痰和痰液的吸出。6,in the sputum of patients often have the cough reflex,which is conducive to suck out the sputum and sputum.,（四）拔管的护理(four)nursing extubation拔管应在病情稳定，呼吸肌功能恢复，咳嗽有力，Extubation should be in a stable condition,respiratory muscle function recovery,powerful cough,能自行排痰，解除对气管切开的依赖心理时，才能进行堵塞试
29、验。sputum can itself,the lifting of the tracheotomy psychological dependence,to blockage tests.堵管时，一般第一天塞住1/3，第二天塞住1/2，第三天全堵塞，Plugging,generally the first day with 1/3,the very next day and third days 1/2,jam,如堵24-48小时后无呼吸困难，能入睡、进食、咳嗽即可拔管。such as blocking without respiratory 24-48 hours after the dif
30、ficult,can sleep,eating,cough to extubation.拔管后的瘘口用75%酒精消毒后，用蝶形胶布拉拢2-3天即可愈合，After extubation fistula after disinfection with 75%alcohol,tape over 2-3 days can be healed by butterfly,愈合不良时可以缝合。早期拔管可降低气管感染、溃疡等并发症的发生。poor healing can suture.Can reduce trachea infection,ulcer complications early extubation.,谢 谢！Thank you.,
