肺动脉气管换位联合滑动气管成形术患儿的气道护理

Airway nursing care of a child undergoing pulmonary artery and trachea transposition combined with slide plasty

报告1例行肺动脉气管换位联合滑动气管成形术患儿的气道护理经验。针对本例患儿术后极易并发气管软化、吻合口感染、吻合口狭窄等气道梗阻问题,加强围术期有效呼吸道管理,尤其是术后气道护理:做好有创通气管理,预防撤机失败;给予持续气道正压通气,行序贯治疗;调整术后体位,避免气道受压;应用振动筛孔雾化吸入,预防肺部炎症;配合纤维支气管镜,及早发现气道并发症。本例患儿经过18 d的精心治疗和护理,病情稳定,顺利转入心脏外科继续治疗。目前患儿已出院,呼吸平稳,喂奶无呛咳。

This paper reported the airway nursing experience of a child undergoing pulmonary artery and tracheal transposition combined with slide plasty with pulmonary artery sling.In order to solve the problem of airway obstruction such as tracheomalacia,anastomotic infection and anastomotic stenosis,we strengthened the perioperative effective airway management,especially the postoperative airway nursing,invasive ventilation management to prevent weaning failure;gave continuous positive airway pressure ventilation and sequential treatment;adjusted the postoperative position to avoid pressure on airway;take vibrating screen atomization inhalation to prevent pulmonary inflammation;cooperated with fiberoptic bronchoscopy for early detection of airway complications.After 18 days of careful treatment and nursing,the patient’s condition was stable and no airway obstruction occurred,so he was transferred to cardiac surgery for further treatment.At present,the child has been discharged,he could breathe stably without choking and coughing during feeding.