气管切开危重患者并发气管食管瘘1例的护理体会

Nursing experience of one critical patient with esophagotracheal fistula after tracheotomy

目的分析1例气管切开危重患者并发食管气管瘘的原因,探讨如何对气管切开并发气管食道瘘危重患者进行护理及其长期留置人工气道护理。方法回顾分析此例气管切开患者的临床资料及发生气管食道瘘后所实施的护理干预。结果气管切开并发气管食管瘘患者发生吸入性肺炎概率大大降低。结论长期留置人工气道的患者发生气管食管瘘的基础和主要原因是气管壁切开破坏了结构和稳定性,加之套管置入及其球囊长期压迫损伤管壁薄弱的膜部结构。选择合适的套管型号、套管固定方法,减少对气管的机械性刺激、防治肺部感染,加强营养支持是气管切开术后避免并发及护理气管食管瘘的有效措施。

Objective To analyze the causes of patients with esophagotracheal fistula,in order to discuss how to use the nursing on critical patient with esophagotracheal fistula after tracheotomy and the nindwelling artificial airway in the long time.Methods Clinical data of a patient with tracheotomy and nursing intervention after esophagotracheal fistula were analyzed retrospectiely.Results The chance of aspiration pneumonia in patient with esophagotracheal fistula after tracheotomy was greatly reduced.Conclusion Foundation and primary cause to patient with esophagotracheal fistula after tracheotomy are that structure and stability of bronchia are damaged after tracheotomy,together with drivepipe imbedding and the wall of the weak membrane structure is damaged because of long compression by sacculus.Suitable pipe casing model,the way of bushing are selected to reduce the mechanical excitement and the lung infection,and strengthen the nutritional support in order to avoid the complication and make the more effective nursing to esophagotracheal fistula after tracheotomy.