蛛网膜下腔出血行气管切开后拔管困难患者的康复护理1例

Rehabilitation care for a patient with difficulty in extubation after tracheotomy for subarachnoid hemorrhage

目的总结1例蛛网膜下腔出血患者行气管切开后拔管困难的康复护理过程。方法74岁女性患者,因脑出血恢复期于2021年10月18日收入广州医科大学附属第二医院。主要康复问题包括气管处于造口状态伴吞咽困难、双侧肢体肌力减退、日常生活部分依赖、认知和言语功能障碍等。针对该患者的康复要点,我们组建了多学科团队并制订了个性化康复护理计划,主要包括呼吸功能康复护理、吞咽功能康复护理、肢体功能康复护理、认知障碍康复护理、气管切开堵管和拔管训练6个方面,为患者提供一体化、个性化和精准化的康复护理。结果经过系统康复护理后,患者在入院第25天时成功堵管并顺利拔除气管插管,在第37天病情稳定时办理出院。结论蛛网膜下腔出血气管切开后拔管困难患者临床少见,总结拔管前的康复护理要点,为临床提供参考。

Objective To summarize the rehabilitation and nursing process of a patient with difficulty in extubation after tracheotomy for subarachnoid hemorrhage.Methods A 74-year-old woman in the recovery period of cerebral hemorrhage was admitted to The Second Affiliated Hospital of Guangzhou Medical University on October 18,2021.The main rehabilitation problems included tracheostomy with dysphagia,bilateral limb muscle strength loss,partial dependence on daily living,and cognitive and speech dysfunction.According to the patient's rehabilitation points,we set up a multidisciplinary team and developed a personalized treatment and rehabilitation plan,which mainly included six aspects:respiratory function rehabilitation nursing,swallowing function rehabilitation nursing,limb function rehabilitation nursing,cognitive impairment rehabilitation nursing,tracheotomy tube blocking,and extubation training.We provided the patient with integrated,personalized,and precise rehabilitation nursing.Results After the planned rehabilitation treatment and nursing,the tracheal intubation was successfully blocked and removed on the 25th day,and the patient was stable and discharged from hospital on the 37th day after admission.Conclusions Extubation difficulties can occur in subarachnoid hemorrhage patient with tracheotomy,and is rare in the clinic.It is important to summarize key points of rehabilitation care,offering evidence-based references for the clinical staff.