人工气道气囊的管理课件

无忧PPT整理发布 人工气道气囊的管理 气管导导管多采用聚氯氯乙烯烯材料，前端带带有气 囊，用以封闭闭气道及相对对固定气管导导管。并 实实行控制呼吸或辅辅助呼吸。因此气囊的管理 非常重要，如护护理不当，易造成多种且严严重 的并发发症。 无忧PPT整理发布 气囊的管理 气囊充气不足和气囊漏气 易导致导管与气管间密闭不良、 漏气 气囊充气过度 压迫气管壁，气管粘膜易缺血坏死 、糜烂而形成溃疡，也可损伤血管 而出血，甚至发生气管食管瘘和无 名动脉破裂致死亡 无忧PPT整理发布 气囊的压力 u目前气管插管的气囊多为大容量低压 气囊，注气后呈圆柱状膨起，与气管 粘膜接触面积较大，2530mmHg的 气囊压力能终止气管壁的动脉循环， 一起粘膜缺血、坏死，气囊压力 18.5mmHg一起气管粘膜静脉回流 受阻，出现淤血。气囊压力过低则不 能有效封闭气囊与气管之间的间隙。 u理想的气囊压力为有效封闭气囊与气 管间隙的最小压力，即毛细血管灌注 压，大约为18.5mmHg，这种压力可 以较好的保障气道粘膜的血液供给。 可采用测压装置测量气囊压力。 无忧PPT整理发布 无忧PPT整理发布 气囊充气量 一般充气不超过810ml p最小闭合容量技术 气囊充气后，吸气时恰好无气体漏出 方法：将听诊器置于患者气管处向气囊内注气，直到听不到漏气声为止，抽出 0.5ml气体，可闻及少量漏气声，再注气，直到再吸气时听不到漏声为止 优点：可减小气囊对气管壁的损伤，不易发生误吸，不影响潮气量。 p最小漏气技术 气囊充气后，吸气时允许有少量气体漏出 方法：是将听诊器置于患者气管处，听其漏气声。向气囊内缓慢注气直到听不 到漏气声为止。然后从0.1ml开始抽出气体，直到听到漏气声为止。 优点：预防气囊对气管壁的损伤 缺点：易发生误吸，增加肺内感染几率 无忧PPT整理发布 气囊放气 以往认为，气囊常规放气-充气，其主 要目的是防止气囊压迫导致气管粘膜损 伤。 目前认为，气囊定时放气是不需要的。 其原因主要有以下三点 气囊放气后，1h内气囊压迫区的粘膜毛细血 管血流也难以恢复，气囊放气5min就不可能 恢复局部血流 常规的定时放气-充气往往使医务人员忽视充 气容积或压力的调整，反而易出现充气过多 或过高的情况 对于机械通气时的危重患者，气囊放气将导 致肺泡通气不足，引起循环波动。因此为重 患者往往不能耐受气囊放气 无忧PPT整理发布 气囊放气主要应用于以下情况 气道峰压力是影响气管最大内径的主要因素。当气 道峰值压力明显增高或减低时，为避免气道压力过 高或过低，应将气囊放气，重新充气 清除囊上滞留物时 无忧PPT整理发布 细菌繁殖的培养基 在气管插管给予通气治疗的整个过程 中，气囊上的滞留物存在于声门与气 囊之间的这一死腔内，是微生物繁殖 的良好培养基，且多为抗生素筛选的 耐药菌。 有报道，呼吸道分泌物培养及结果前5 位的细菌依次为：铜绿假单胞菌、肺 炎克雷伯菌、大肠埃希菌、聚团肠杆 菌及表皮葡萄球菌，前4位为革兰阴性 杆菌 气囊放气后，含有以上杆菌的滞留物 容易流直下呼吸道导致呛咳、窒息及 感染 无忧PPT整理发布 有效清除囊上滞留物的方法 气流冲击法 在气囊放气的同时，通过呼吸机或手动皮囊经人工 气道给予较大的潮气量，在塌陷的气囊周围形成正 压，将滞留物冲到口腔，从而达到清除气囊上分泌 物，防止气囊放气后分泌物流入气管的的目的 持续声门下吸引 在声门与气囊间放一引流管，放置的背侧气囊上缘并 固定，与气管套管并行引出体外，可接负压吸引装 置持续吸引分泌物 无忧PPT整理发布 1.Chinese except friendships to be more lasting. 2.Different foundations for friendships. 3.Westerns expect friends to be independent. 4. Chinese usually expect more from their friends. 无忧PPT整理发布 Chinese except friendships to be more lasting. For Chinese a true friendship endures throughout life changes. Chinese are friends even if they havent spoken for 20 years. If you shared something at one time, then all your life you are friends. This is the best of guanxi(关系), the Wide Web that connects Chinese through time and space. So, we can say Chinese invented the Internet long before Bill Gates was born. In North America, even the relationship in which people feel close and tell each other personal problems may not survive life changes such as moving to another city, graduation from a university or marriage. If the people do not see each other regularly, the relationship is likely to die. 无忧PPT整理发布 Different foundations for friendships. Chinese friends share “ things in common”: a task, a class, the hometown. Friendships are formed by people who work or go to school together. You may or may not like the person, but if he or she can do something for you because of his position or job, you can be friends. But in North America, business and friendship are kept separate. The friendships are usually tied to specific activities. A person may have work friends and leisure (休闲时) activity friends. Also friends tend to have similar financial circumstances, because friendship in the West is based on equality. 无忧PPT整理发布 Westerns expect friends to be independent. Why? Its because their friendship is mostly a matter of providing emotional support and spending time together, so they do not feel comfortable in a relationship in which one person is giving more and the other is dependent on what is giving. A westerner will respond to a friends trouble by asking “What do you want to do?” The idea is to help the friend to think out the problem and discover the solution he or she really wants and then to support the solution. Chinese friends give each other more concrete help. A Chinese will use personal connections to help a friend get something hard to obtain. They give each other money and might help each other out financially over a long time. 无忧PPT整理发布 Chinese usually expect more from their friends. In the West, you can certainly ask a friend to do something with you, but you recognize that your friend may say no, if he or she gives you as reason. You would not expect a friend to drop everything to respond to a non-urgent need such as shopping. Nor would you expect a friend to recognize and respond to your wishes without stating them. A friend in China is someone who offers help without waiting to be asked. There are few limits to what