小儿支气管异物取出术中并发症原因分析及护理

The causes of complications at taking out foreign bodies in infant bronchus and the nursing

笔者报道小儿气管支气管异物取出术中常出现喉痉挛、喉水肿、张力性气胸、呼吸心跳骤停等并发症,分析原因:(1)麻醉过浅窥镜刺激,插镜次数多;(2)小儿喉组织松软,粘膜下组织疏松而少纤维,异物进入呼吸道出现炎症反应;(3)异物钳尖穿破支气管,术中不正确高频正压通气;(4)麻醉过浅刺激喉气管后引起迷走神经反射出现呼吸心跳骤停。并针对原因提出护理对策:(1)术前准备好急救物品、器械,确保性能良好;(2)术中监测患儿心率、心律、呼吸、血氧饱和度;(3)异物取出后密切观察患儿的血氧饱和度和二氧化碳浓度;(4)巡回护士、麻醉医师、手术医生密切配合。以提高手术抢救成功率。

The author reported in this paper the complications at taking out foreign bodies in infant bronchus like laryngeal edema, aryngospasm, tension pneumothorax, sudden cessation of respiration and heart beat and pointed out the causes include:(1)Less anesthesia and stimulus of the endoscope or too many times of insertion of the endoscope; (2) Infant laryngeal tissues are tender and soft and the submucosa tissues loose and lack of fibers so that inflammation reaction emerged by foreign bodies entering the respiratory tract; (3) The foreign body forceps cut the bronchus or improper high-frequency positive pressure ventilation; (4) The anesthesia was so superficial that the stimulus to laryngeal trachea produced sudden cessation of respiration from vagoreflection. The nursing measures she put forward included:(1) preoperative preparation of emergency articles and instruments to ensure their behaviors;(2) operative monitoring of heart rate, cardiac rhythm, respiration, blood oxygen saturation; (3) close observation of blood oxygen saturation and carbon dioxide concentration after taking out the foreign bodies; (4) close cooperation of circulating nurses, anesthetists and doctors to raise the success rate of surgery.