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气管切开患者的护理Thegastubeiscutopenthepatientcare四川大学华西医院：刘虹运WestChinaHospitalofSichuanUniversity:YangLi2013.2.18February18,2013（一）术后护理(a)thepostoperativenursing1、将患者安置于安静、清洁、空气新1,patientswillbeplacedinthequiet,clean,freshairinthewards,鲜的病室内，室温保持在21℃，atroomtemperaturemaintainedat21℃,humiditywasmaintainedat60%,湿度保持在60%，气管套口覆盖2-4层温湿trachealsleeveopeningcoverthetemperatureof2-4纱布，室内经常洒水，或应用湿器，定时wetgauze,indoorregularwatering,ortheapplicationofhumidifier,以紫外线消毒室内空气。timedtoultravioletdisinfectionofindoorair.2、手术之初患者一般取侧卧位，以利In2,operationatthebeginningofthegenerallateraldecubitusposition,inorder于气管内分泌物排出。tofacilitateendotrachealsecretions.但要经常转动体位，防止褥疮并使肺各部分Buttotheregularrotationposition,preventingbedsoreandthelungofeachpartof呼吸运动不致停滞。respiratorymovementnotstagnation.3、备齐急救药品和物品，某些物品应置床头。3,preparefirst-aidmedicinesandarticles,someitemsshouldbeplaced.同号气管套管，气管扩张器，外科手术剪，Thesamenumberoftrachealcannula,trachealdilator,surgicaloperationscissors,止血钳，换药用具与敷料，生理盐水和饱和重碳酸钠液，forceps,dressingappliancesanddressing,salinewaterandsaturatedsodiumbicarbonatesolution,导尿包、吸引器，氧化气筒，呼吸机，urethralcatheterizationbag,suctionpump,oxidation,ventilator,手电筒等都应备齐，并妥为存放，以备急需。flashlightshouldprepare,andproperlystored,forarainyday.4、谨防气管导管引起阻塞：阻塞原因一是气囊滑脱堵塞，4,bewareofthetrachealcatheterobstructive:obstructionisablockageairbagspondylolisthesis,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，twoisbondedintocallussecretionobstruction,suchassuddenonsetofdyspnea,cyanosis,patientrestlessness,应立即将套管气囊一起取出检查。shouldimmediatelycheckoutwiththesleevebag.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，Inordertopreventtheairdetachment,attentionshouldbepaidtotheballoontiedfirmly,willheadouttracheotomywound,并经常牵扯检查是否牢固，及时清除结痂。andofteninvolvecheckwhetherthefirm,thetimelyremovalofincrustation.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。Inaddition,inreplacementofthecleaninganddisinfectionoftheconduit,preventcottongauzeleftinthepipe.5、及时吸痰：气管切开的病人，咳嗽排痰困难，5,suctiontime:thepatientstracheotomy,coughandexpectorationdifficulties,应随时清除气道中的痰液，吸痰时要严格遵守操作规程，shouldbekeptclearofairwaysputum,sputumaspirationtostrictlyabidebytherules,注意无菌观察。payattentiontoasepticobservation.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,adequateshumidification:patienttracheotomylosehumidificationfunction,easytoproduceairwayobstruction,和继发性感染等并发症pulmonaryatelectasisandsecondarycomplicationssuchasinfection.常采用下列方法湿化：Oftenusedthefollowingmethods:（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)intermittenthumidificationhumidification,physiologicalsaline500mlplusgentamicin120000units,eachtimeafterendotrachealsuctionslowlyintothetrachea2-5ml,每日总量约200ml，也可间断使用蒸气吸入器、雾化器做湿化；dailytotalabout200ml,canalsobeusedintermittentlyvaporinhaler,nebulizerdohumidification;（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)continuoushumidificationmethod,inordertoinfusionwayhumidificationfluidthroughscalpneedledropsslowlyintothetrachea,droppingspeedcontrolineveryminute4-6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。4-6drops,eachdayandnightisnotlessthan200ml,thehumidificationbottlecanbeaddedtoantibioticsorotherdrugs.7、预防局部感染：气管内套管每取出清洁消毒2-3次，7,topreventlocalinfection:endotrachealtubeseachcleaned2-3times,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。theoutertubeisgenerallyinthe1weeksaftertheoperationtheformationofsinusafterincisionoftracheacanbepulledouttoreplacethedisinfection.气管导管的纱布应保持清洁干燥，每日更换。Thetrachealtubegauzeshouldbekeptcleananddry,dailychange.经常检查创口周围皮肤有无感染或湿疹。Alwayscheckthewoundaroundwithnoinfectionorskineczema.导管先用0.5%新洁尔灭浸泡，然后煮沸消毒，Catheterwith0.5%bromo-geraminumsoak,andthenboildisinfection,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。rinsewithwaterafterboilingdisinfectioncanbeused.Serpentinepipe0.5%Bromogeraminesoaking,dailychange.8、关心体贴病人，给予精神安慰：。8,caringpatients,togivespiritualcomfort:患者经气管切开术后不能发音，可采用书面交谈或Patientswithtracheotomypatientscannotpronunciation,canusewrittenconversationorgesture,preventionofpatientswithirritableandI动作表示，willcasingpulling,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whennecessary,trytofixthehands（二）气管切开常见并发症(two)thecommoncomplicationsoftracheotomy1、脱管：常因固定不牢所致，脱管是非常紧急而严重的情况，1,offtube:oftenduetofixedduetopoor,offtubeisveryurgentandseriouscondition,如不能及时处理将迅速发生窒息，停止呼吸。Ifnottimelytreatmentwillquicklyasphyxia,stopbreathing.2、出血：可由气管切开时止血不彻底，或导管压迫、In2,hemorrhage:bytracheotomyhemostaticnotcomplete,orcatheter,刺激、吸痰动作粗暴等损伤气管壁造成。stimulation,oppressionofsputumsuctionofviolentactionanddamagecausedbytrachealwall.患者感胸骨柄处疼痛或痰中带血，一旦发生大出血时，Patientswithsternalpainsenseorsputumwithblood,oncetheoccurrenceofbleeding,应立即进行气管插管压迫止血。shouldimmediatelyendotrachealintubationcompressionhemostasis.3、皮下气肿：为气管切开术比较多见的并发症，3,subcutaneousemphysema:tracheotomyismorecomplications,气肿部位多发生于颈部，偶可延及胸及头部。emphysemasiteoccurredintheneck,chestandheadcanevenextendto.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。Whenthesubcutaneousemphysema,availableinemphysemaedgeispaintedtomarktheviolet,toobservetheprogressofeli.4、感染：亦为气管切开常见的并发症。4:also,infectionisacommoncomplicationofincisionoftrachea.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。Andairdisinfection,indoorsuctionoperationofpollutionandtheoriginalconditionof.5、气管壁溃疡及穿孔：气管切开后套管选择不合适，5,trachealwallulcerandperforation:afterincisionoftrach