呼吸重症患者机械通气护理新进展.ppt

2021/3/27 * 开放式吸痰与密闭式吸痰各方面的比较 项目 开放式吸痰 密闭式吸痰 方式 患者暂停机械通气 患者持续机械通气 时间 较长 短暂 吸痰效果 不能很好把握吸痰管、插入深度，易造成气道粘膜损伤及吸痰不彻底 能确切吸痰深度，可减少气道粘膜损伤及定位痰液多的部位行彻底吸痰 污染程度 产生大量含菌微粒，污染各种物品表面易造成空气污染和交叉感染 不造成空气污染，且能避免吸痰引起的交叉感染 耐受程度 不易耐受，易烦躁，容易引起胸闷，气急，剧烈呛咳及呼吸困难等表现 易耐受，稍烦躁，无明显胸闷气促及呼吸困难，有呛咳 心率 增快，易因暂停脱机缺氧致使心律失常 增快，不会因脱机缺氧致使心律失常 2021/3/27 * 答题: 有创呼吸机常用连接方式 气管插管（经口,经鼻） 气管切开 最适的气囊压力及气道温度、湿度 最适的气囊压力为18.4~21.8mmHg。 气道内的气体温度达到37°C,相对湿度100%。 2021/3/27 * 谢谢! 成人门齿到声门的距离是12～15cm，声门至隆突是10～15cm。 Respiratory mucosal and lung structures and functions may be severely impaired in mechanically ventilated patients when delivered gases are not adequately conditioned. Although under- and over-humidification of respiratory gases have not been defined clearly, a safe range of temperature and humidity may be suggested. During mechanical ventilation, gas entering the trachea should reach at least physiologic conditions (32 degrees C-34 degrees C and 100%relative humidity) to keep the ISB at its normal location. Clinicians must keep in mind that relative humidity is more important than absolute humidity: the warmer the gas, the higher the risk of tracheal mucosa dehydration and proximal airway obstruction. Practical assessment of the adequacy of the humidification system in use is not easy. The consistency (thin, moderate, or thick) of the patients sputum should be evaluated regularly [47]. Full saturation of inspiratory gases is likely when water condensation is observed in the flex tube [91,92]. Nevertheless, no clinical parameter is accurate enough to detect all the effects of inadequate conditioning [45]. When mechanical ventilation is extended beyond several days, adequate conditioning of respiratory gases becomes increasingly crucial to prevent retention of secretions and to maximize mucociliary function; a requirement that respiratory gases reach at least physiologic conditions is appropriate. Respir Care Clin N Am. 2006 Jun;12(2):233-52. * * * 2021/3/27 * 最小漏气技术 特点: 可预防气囊对气管壁的损伤。 由于有少量漏气,口