40例严重胸外伤气管切开术后临床观察与呼吸道监护研究

Clinical observation and guardianship of respiratory passages after tracheotomy in 40 cases of severe chest traumas

目的加强严重胸外伤气管切开术后呼吸道管理,有效防止肺部并发症的发生,提高重危患者抢救成功率。方法回顾性总结本科2005年12月到2008年12月40例严重胸外伤气管切开术后患者临床观察和呼吸道管理经验,提出更有效的呼吸道监护措施。结果40例气管切开术后患者在积极治疗原发病、纠正休克、止血、抗感染等紧急救治的同时予以有效的呼吸道监护和管理,4例呼吸衰竭很快得到纠正,32例呼吸困难迅速好转。38例未发生肺部并发症而治愈出院,1例发生ARDS转ICU治疗,另1例因重度失血性休克抢救无效死亡。结论规范严重胸外伤气管切开术后呼吸道管理行为,积极做好呼吸道监护工作,防止肺部并发症的发生,是提高重危患者护理质量的关键。

Objective To enhance the administration of clinical observation and the custodial care of respiratory passages in the severe chest trauma patients who underwent tracheotomy for preventing the pulmonary complications, and improving the achievement ratio of the salvage in the severe cases. Methods The records of 40 chest trauma patients who underwent incision of tracheal were retrospectively reviewed. We summarized the experience of clinical observation and the administration of respiratory passages and reviewed the optimized measures. Results With the emergency aid and treatment including curing the primary disease, correcting shock, hemostasis, anti-infection and effective guardianship of respiratory passages,4 cases with respiratory failure were cured quickly,32 cases with dyspnea got better fast. Thirty eight cases were cured and discharged without iatrogenie pulmonary infection. However,one patient transfer to ICU for ARDS and one patient died for severe hemorrhagic shock. Conelusion Administration of respiratory passages should be standardized in the cases with severe chest trauma and tracheotomy. It is recommended to optimize the custodial care in respiratory passages,prevent the pulmonary complications and improve the quality of nursing care.