32例重型颅脑损伤继发呼吸衰竭护理.DOCVIP

临床医学论文-32例重型颅脑损伤继发呼吸衰竭护理 【摘要】? 目的? 回顾性总结32例重型颅脑损伤后继发急性呼吸衰竭的护理经验。方法? 重型颅脑损伤后继发呼吸衰竭的患者予以病因治疗，并予以气管切开、机械性通气及亚低温等综合治疗，加强呼吸道护理及营养支持治疗。结果? 经治疗良好14例(43.75%)，中残6例(18.75%)，重残2例(6.25%)，死亡10例(31.25%)。结论? 重视术前准备，加强术后生命体征的监测，做好呼吸道、引流管的护理，及时使用机械通气、亚低温疗法，早期给予营养支持，是该病的护理重点，也是降低死亡率的有效措施。??? ??? 【关键词】? 颅脑损伤；呼吸衰竭；机械性通气；急性；护理??????????????? 【Abstract】? Objective? In this paper，a retrospective survey of nursing of 32 patients with severe craniocerebral injury with acute respiratory failure was conducted.Methods? The patients were treated to enforced etiological treatment，incision of trachea，mechanic ventilation，deuto-hypothermy.The respiratory passage nursing and nutritional support treatment were enhanced.Results? 32 cases were treated.14 cases of them were good(43.75%)，6 cases were mid-handicap(18.75%)，2 cases were re-handicap(6.25%)，10 cases were died(31.25%).Conclusion? The summary suggested that it is important to pay attention to the preparation before operation，the observation of life sign and the nursing of respiratory tracts and drainage-tubes，the use of respirators，sub-low temperature and nutrition early after operation.It is also an effective measure to decrease the death rate.??? ??? 【Key words】? craniocerebral injury；respiratory failure；mechanic ventilation；acute；nursing??? ??? 重型颅脑损伤的特点包括病情危重，发展迅速，复杂多变，并发症多，救治困难，病死率高。并发症中以呼吸衰竭最为常见，也是重要的死亡原因［1］。我院神经外科ICU自2001年6月～2004年12月共收治颅脑外伤继发呼吸衰竭32例。经采取针对性护理措施，在治疗护理原发伤、保护和恢复脑功能的同时，特别加强对呼吸功能的监测和管理，抢救了许多危重病人的生命，使其顺利康复，现将护理体会报告如下。??? ??? 1? 临床资料??? ??? 1.1? 一般资料? 本组32例患者，男25例，女7例，年龄10～68岁，平均26.25岁。??? ??? 1.2? 受伤原因? 车祸伤24例，坠落伤6例，打击伤2例。??? ??? 1.3? 损伤类型? 闭合性伤28例，开放性伤4例，合并其他部位损伤24例。入院时GCS评分：6～8分(重型)22例，3～5分(特重型)10例。急性呼吸衰竭诊断标准参照文献［2］判断，其中入院时已发生呼吸衰竭8例，术后2～24h发生急性呼吸衰竭24例。急性呼吸衰竭的类型：中枢型呼吸衰竭18例，外周性呼吸衰竭14例。??? ??? 1.4? 排除标准? 合并有呼吸系统疾病、有严重的心肝肾功能障碍者、糖尿病患者等不列入本研究所选病例的范围。??? ??? 2? 治疗方法??? ??? 2.1? 病因治疗? 本组32例均于入院30min～12h后行大骨瓣减压颅内血肿清除和(或)挫伤灶坏死组织清除术，其中8例同时进行骨折固定和(或)胸腔闭式引流术。所有病例在心肺功能监测下给予补液、脱水、抗生素和亚低温等治疗。??? ??? 2.2? 对症治疗? 本组气管插