气道净化与气囊管理剖析.pptVIP

* It is critical for clinicians, patients and caregivers to understand the difference between the various methods of mobilizing and/or clearing secretions. Secretion Mobilization techniques are designed to loosen and mobilize secretions from the lower airway to the upper airway by the use of vibrations. Secretion Removal techniques mobilize secretions and remove secretions from the lungs. * This slide simply shows methods used to achieve maximal insufflation, usually prior to a spontaneous cough. Other means include a volume ventilator, frog breathing and Mechanical Insufflation. * The next technique that we will discuss is clearing of secretions using Mechanical Insufflation- Exsufflation or MI-E. This not a new technique, in fact it has been used since the 1950’s for Polio patients. It has been known through the years as the IN-Exsufflator but the modern version is called the CoughAssist. This therapy works nonivasively to removed retained secretions. A gradual hyperinflation is provided with positive pressure followed by a rapid shift to a negative pressure which simulates a cough. This therapy can be administered by mask, mouthpiece or invasively through a tracheostomy tube. * 山东省千佛山医院护理部 张淑香 人工气道管理 * * 气道的净化 “动员”分泌物 松解分泌物并将之移动到上气道 “清除”分泌物 把移动到上气道的分泌物清除出肺部 辅助咳嗽技术和吸引技术 * * 分泌物“动员”技术 包括咳嗽、拍背、震颤、体位引流、吸引、缩唇腹式呼吸练习等方法. 叩拍法 (percussion)原理：一般认为叩拍力可通过胸壁传到气道，将支气管壁上的分泌物松解，然后随病人咳嗽排出体外或吸出。 患者侧卧,护士手呈空心掌,从肺底由外向内、由下向上拍背,左右侧卧位各1次 肋缘下双手交替扣击操作,每侧5-10分钟左右,频率1-2次每秒,2-3次/日. * * 手动辅助咳嗽 * * 机械性吸-呼气技术 (MI-E) 模仿咳嗽，向气道内正压送气（吸气）后，使患者肺部充分膨胀 快速切换至负压（呼气），产生替代正常咳嗽的峰流速 能连接面罩、气管插管/气切套管 Cough Assist * * 清除分泌物--气道吸引技术 吸痰前评估 ：定时听诊,按需吸痰 安全吸痰，吸痰前后给纯氧 密闭吸痰：不要断开呼吸机 无菌吸痰：“待气管如血管” 浅度吸引代替深度吸引 吸引时间小于15s 吸痰管内径少于气管套管内径1/2 * * 吸痰时机 患者咳嗽或有呼吸窘迫时 容控气道高压报警，压控潮气量低报警 氧分压或氧饱和度突然降低时 清醒病人自诉有痰时 肺部听诊有痰鸣音 胸肺物理治疗翻身扣背后 雾化吸入后 清除分泌物---气道吸引技术 ? AARC 2010气道吸引指南最新推荐10项操作标准 –发现气道内分泌物时按需吸引，而不是按时吸引。(1C) – 吸引过程影响氧合状况时，建议预给氧。(2B) – 建议机械通气患者避免断开呼吸机连接进行吸引操作。(2B) – 建议浅度吸引代替深度吸引，尤其在给婴幼儿患者做吸引操作时。(2B) – 建议