肝移植术后机械通气患者再次插管的原因及其护理对策

Cause Analysis and Nursing Strategy of Trachea Reintubation for Patients with Mechanical Ventilation Following Orthotopic Liver Transplantation

目的探讨肝移植术后机械通气患者再次插管的原因及护理对策。方法回顾性分析2004年1月至2009年12月期间237例肝移植术后机械通气患者的病例资料。结果 30例患者发生再次插管,其中14例存活、16例死亡,病死率为53.3%。术后并发呼吸道阻塞、呼吸功能不全、出血、急性左心功能衰竭是再次插管发生的主要原因。结论再次插管发生与否对患者的预后起关键性作用。通过加强患者呼吸道湿化、保持呼吸道通畅,加强对高危患者的监护、预防突发事件的发生,加强预见性护理、预防并发症的发生,可有效降低再次插管率,降低病死率,利于患者术后康复。

Objective To explore the causes and nursing strategy of trachea reintubation for patients with mechanical ventilation following orthotopic liver transplantation （OLT）. Methods Clinical data of 237 postoperative patients with mechanical ventilation following OLT from January 2004 to December 2009 were retrospectively analyzed. Results Of the 30 patients underwent trachea reintubation, 16 died and 14 survived with the fatality rate of 53.33%. Sputum retention, blocked airway,respiratory failure, bleeding and acute left ventricular failure were the main causes of tachea reintubation for postoperative patients with mechanical ventilation following OLT. Conclusion Trachea reintubation is one of the key factors in prognosis. Humidifying respiratory tract, keeping respiratory tract unobstructed, monitoring on patients at high risk,enhancing predictable nursing and preventing complications can effectively reduce trachea reintubation and fatality rate,as well as improve the rehabilitation of patients.