纤支镜检查

,ThemeGallery PowerTemplate,纤维支气管镜检查及护理,。,特点一,特点二,管径细（6mm）、可曲度大，可视范围广、照明清晰度高,安全，但是易插入段、亚段支气管甚至更细支气管,原因不明的咯血或痰中带血。原因不明的咳嗽，难以用吸烟或气管炎解释，尤其是中老年人，应接受支气管镜检查。出现局限性肺气肿、阻塞性肺炎或肺不张、呼吸困难等情况时。发生原因不明的喉返神经麻痹或膈神经麻痹时。诊断不明的支气管、肺部疾病或弥漫性肺部疾病诊断困难时。,适应症,绝对禁忌；神智混乱而无法控制的病患，有出血倾向者，低血氧患者，急性呼吸性酸中毒者，严重心律不整或高血压控制不佳者，未曾治疗之开放性肺结核患者相对禁忌：心肺功能不良者，肺动脉高血压者，气喘发作或控制不良者，大量咯血者，凝血机制异常者。,禁忌症,病人准备,术前准备,注意事项,纤支镜的检查方法,操作步骤,术前34h禁食、禁饮，检查开始前排空大小便。检查时请带上面巾纸一包，以备术中使用。,病人准备,向病人解释目的、配合事项。查血小板和出血、凝血时间、胸片、心电图、血气分析。了解病史，确定有无适应症和禁忌症。仔细阅读影象学资料（胸部CT片）。做好解释，争取合作，有活动性义齿的应取出。签手术知情同意书。,术前准备,2%利多卡因雾化吸入麻醉咽喉部，术前半小时阿托品肌注，减少呼吸道分泌物。,麻醉, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,洗手、戴手套，帽子，检查器械经鼻，会厌，进入声门，动作要轻柔观察纤支镜进入顺序活检肺周围病灶的活检和刷检及时吸引分泌物处理镜面模糊密切观察病人,操作步骤, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,从鼻插入,从口插入,插入纤支镜, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,纤维支镜, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,术后注意,告知病患两小时以后进食、水。行肺活检者应注意观察有无咯血和气胸。发热者，给抗菌素治疗。,操作视频, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,术后可能有痰中带血，告之不要担心，轻轻咳出痰液和血液，如果有大量活动性出血请立即告知医务人员。如有声嘶或咽喉疼痛，可给与雾化吸入。,温馨提示,术前准备： 向病人解释目的、配合事项。查血小板和出血、凝血时间、胸片、心电图、血气分析。环境准备：环境清洁、无尘，室温不低于200C。医务人员准备：洗手、带口罩、带帽子。,护理操作,术前前半小时肌注阿托品、口服地西泮、静注50%葡萄糖。检查开始前嘱病人排空大小便。使用呼吸机的患者将FIO2调至100%。物品准备：纤维支气管镜、吸引器、冷光源、活检钳、细胞刷、喉头喷雾器、麻醉药、镇静药、抢救药及物品, Image information in product Title Image : www.photosclub.co.kr Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,协助摆体位:去枕仰卧位，头部后仰，肩部垫一软枕，下颌略抬高，不能平卧者，可取坐位或半坐位配合经纤支镜滴入麻醉剂作好标本采集工作操作配合纤维支气管镜床旁预处理：使用盐水冲洗干净，表面用75%酒精纱布擦拭消毒。整理用物、记录。,术中护士应严密观