1例急性肝衰竭患者气管阻塞性纤维素性假膜环形脱落的护理

Nursing care of an acute liver failure patient with annular abscission of obstructive fibrinous tracheal pseudomembrane

总结1例急性肝衰竭患者机械通气期间形成气管阻塞性纤维素性假膜,拔除气管插管后假膜环形脱落的护理。护理要点:早期识别假膜脱落,团队合作急救处理;再次插管后实施个性化气道护理,防止气道损伤加重;积极控制感染,减轻气道炎症反应;加强抗凝护理,促进创伤黏膜恢复;目标导向镇静、镇痛,辅助机械通气;鼻饲期间预防误吸,拔管后恢复吞咽功能。患者再次气管插管3 d后顺利拔管。

To summarize the successful care of a patient with acute liver failure who formed an obstructive fibrinous tracheal pseudomembrane during mechanical ventilation,and whose tracheal pseudomembrane annular abscised after extubation.Key points of nursing include early identification of pseudomembrane abscission,and team collaboration in emergency management;individualized airway care after re-intubation to prevent aggravation of airway injury;active infection control to reduce airway inflammation;strengthening anticoagulation care to promote the recovery of traumatic mucosa;goal-directed sedation and analgesia to assist mechanical ventilation;aspiration prevention during nasal feeding and swallowing function recovery after extubation.The patient was successfully extubated 3 days after re-intubation.