1、广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo1第八章第八章 常用急救技常用急救技术与护术与护理理广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo2 知知识识要点要点 1.了解机械通气技术的适应证和禁忌证2.掌握气管内插管术、气管切开
2、术的操 作方法及护理广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第一第一节节 机械通机械通气气技技术术及及护护理理概概念念: : 机械通气是在患者正常呼吸或氧合功能出现障碍时,用人工方法或机械装置代替、控制或改变自主呼吸运动,给予患者呼吸支持,恢复有效通气并改善氧合的一种通的方式。3广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright
3、 by ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理原理:原理: 建立气道、口与肺泡间的压力差,通过人为产生呼吸动作,不依赖呼吸中枢而替代呼吸中枢,替代神经、肌肉等产生、控制和调节呼吸动作,以改善通气,改善换气,纠正低氧血症。4广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理装置:装置: 口含嘴、面罩、喉罩、气管插管
4、、气管切开5广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理适适应证应证 1、急慢性呼吸衰竭 2、肺部疾病:COPD、重症哮喘、严重 肺感染、 ARDS、间质性肺炎、肺栓塞 3、严重的胸部疾患或呼吸肌无力 4、呼吸中枢失调 5、心肺复苏术后 6、呼吸机治疗6广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright b
5、y ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理禁忌症禁忌症1. 大咯血或严重误吸引起的窒息2. 急性心功能衰竭、AMI3. 低血容量性休克未纠正4. 未行引流或减压的气胸、胸器积液、纵膈气肿 5. 支气管异物7广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理8呼吸囊呼吸囊吸痰机吸痰机人工呼吸机人工呼吸机物品准物品准
6、备备广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第一节 机械通气技术及护理操作方法操作方法 1.检查仪器性能 2.解释操作目的 3.清除呼吸道分泌物,保持呼吸道通畅 4.使用简易呼吸囊9广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLog
7、o操作方法5.使用呼吸机 呼吸机各种参数的选择10项目项目 成人成人儿童儿童呼吸频率(R)1216次/分2025次/分潮气量(Vr)810ml/kg10-12ml/kg呼吸比值(I E) 1 1.521 1.52每分钟通气量(MV) 90100ml/kg100120ml/kg吸入氧浓度 30%40%(50%)30%40%(50%)气道压力 1220cmH2O 820 cmH2O第一节 机械通气技术及护理广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserve
8、d.Company LogoLogo护护理理1.病情观察:胸部体征2. 呼吸机的监测:运转、压力、漏气、氧浓度3. 感染的预防:严格无菌操作 充分湿化气道 ,鼓励并协助病人咳嗽、翻身、叩背,促进痰液的排出。 呼吸机接头每日消毒一次 ,病室用紫外线灯照射12次 /日。及时清理呼吸道分泌物基础护理11第一节 机械通气技术及护理广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo护护理理 4. 防治并发症: 通气不足 通气过
9、度 肺部气压伤 呼吸道感染 循环功能障碍 12第一节 机械通气技术及护理广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第2节 气管内插管术概念 气管内插管术是指将特制的气管导管,通过口腔或鼻腔插入病人气管内。是一种气管内麻醉和抢救危重病人的技术,它有利于清除呼吸道的分泌物保持气道通畅,减少气道阻力,保证有效的通气,为给氧、加压人工呼吸、气管内给药等提供条件。 13广东医学院附属医院AFFILATED HOSPIT
10、AL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo适适应应症症1 呼吸功能不全需行人工加压给氧和辅助呼吸者。2 心脑肺复苏者。3 呼吸道分泌物不能自行咳出者。4 各种全麻或静脉复合麻醉者。5 颌面部、颈部大手术者,呼吸道难以保持通畅者。6 婴幼儿气管切开前需行气管定位者。14第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All righ
11、ts reserved.Company LogoLogo禁忌症1 主动脉瘤压迫气管。2 咽部脓肿、急性喉炎、喉头水肿、喉头黏膜下血肿。3 喉部烧伤、肿瘤、异物存留者。4 下呼吸道分泌物潴留难以从插管内清除者。5 颈椎骨折、脱位者。15第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo物品准备16第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG M
12、EDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo17第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo操作方法操作方法体位: 病人仰卧位,肩部垫高,头尽量后仰, 颈上抬 口咽气管成一直线。18第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDI
13、CAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo开口19第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo暴露会厌、声门 20第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT Al
14、l rights reserved.Company LogoLogo插插管管21第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo确定确定插插管部位管部位 22第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company Log
15、oLogo确定确定插插管部位管部位 23第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo固定24第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo固定固定25第2节 气管内插管术广东医学院附属医院A
16、FFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo固定固定26第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo吸痰吸痰27第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL
17、 COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo经鼻腔明视插管术 28第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo护理1. 根据病人的年龄、性别、身材大小、插管的途径选择导管。2. 如患者呼吸困难或呼吸停止,插管前应先行人工呼吸、吸氧3. 随时观察导管是否通畅。4. 插管后,应定时翻身、叩背、吸痰、遵医嘱雾
18、化及抗感染治疗,以保持呼吸道通畅。29第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo护理5. 吸痰时严格无菌操作,吸痰顺序为气管内口腔鼻腔,每次时间不能超过15秒。 6. 导管留置时间不能过长(72小时)7. 随时观察导管固定情况,防止脱出。8. 每班定时测定插管深度及气囊压力并记录且交班。9. 监测血氧饱和度、心率、血压及血生化指标10. 防止肺不张、肺部感染,加强口腔护理,保持鼻腔、口腔清
19、洁。30第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo注意事项1. 所有用物均应经过消毒才能使用,插管前严格检查插管用物是否齐全,特别注意喉镜灯是否明亮。2. 插管操作应轻柔、敏捷、熟练、准确,勿使缺氧时间过长,以免引起反射性心跳呼吸骤停。3. 使用喉镜注意勿损伤门齿。导管套囊充气不可过多,以免压迫气管粘膜和使导管管腔缩小。4. 插管后氧气不可直接吹向气管导管,吸入气体必须注意湿化,防止气管内
20、分泌物粘稠结痂,影响呼吸道通畅。31第2节 气管内插管术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo第3节 气管切开术气管切开术气管切开术 系切开颈段气管,放入气管套管,以解除喉源性呼吸困难、呼吸机能失常或下呼吸道分泌物潴留所致呼吸困难的一种急救技术。32广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT
21、All rights reserved.Company LogoLogo适适应应症症 1. 迅速解除呼吸道梗阻 2. 需要长时间应用呼吸机辅助呼吸者 3. 有气管异物 4. 预防性气管切开33第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo禁忌症禁忌症 气管切开部位以下占位性病变 严重出血性疾病34第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG
22、MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo物品准备 35第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo操作方法操作方法体位36第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCO
23、M PT All rights reserved.Company LogoLogo麻醉及消毒麻醉及消毒37第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo切口及分离组织 38第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Compa
24、ny LogoLogo切开气管 39第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo插插入入气气管套管管套管 40第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo固定41第3节 气管切开术广东医学院附
25、属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo创口处理 42第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo常常规护规护理理 1. 病室要求 2. 床旁应备有各种急救药品和物品 3. 体位:患者术后取平卧去枕位,或半坐去枕位 4
26、. 病情观察 5. 饮食:术后1周内多给予流质或半流质饮食43第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo气气管切管切开处伤开处伤口的口的护护理理 1. 观察伤口情况 2. 皮肤护理 3. 换药44第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights
27、reserved.Company LogoLogo注意事项 1.严格掌握气管切开的适应症和禁忌症。 2.专人护理。 3.术前慎用镇静剂,以免加重呼吸困难。 4.皮肤切口要保持在前正中线上,防止损伤颈部两侧大血管而引发出血。 5.严禁切断第1气管软骨和环状软骨,以免引起喉狭窄。45第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo注意事项6.进刀时切忌用力过猛,以免穿透气管后壁进入食管,形成气管食管瘘。7.堵管栓子要固定牢固,防止吸入气管。8.气管切开病人吸气,不可将氧气导管直接插入内套管内,可用“丁”字型管或氧罩9.金属内套管每48小时更换一次,并消毒,内套管取出时间不可超过30分钟。10.保持气道湿润通畅。46第3节 气管切开术广东医学院附属医院AFFILATED HOSPITAL OF GUANGDONG MEDICAL COLLAGECopyright by ARTCOM PT All rights reserved.Company LogoLogo47