Search

Rehabilitation experience of lung transplant patients with tracheostomy

The rehabilitation experience of 20 patients with tracheostomy after lung transplantation was reported, and the key points of rehabilitation nursing included sequential oxygen therapy, airway clearance, diaphragm pacing, respiratory training, swallowing training, speech training, exercise training, and gastrointestinal function rehabilitation. Tracheostomy is conducive to airway management and offline extubation in patients assisted by long-term breathing, and promotes patient recovery and discharge through multidisciplinary collaborative rehabilitation nursing integrated case management.

封闭式吸痰管在气管切开患者中的应用与护理

【摘要】 目的 总结封闭式吸痰管在气管切开患者应用过程中的价值。 方法 2008年7月-2009年7月对60例气管切开患者，使用封闭式吸痰管进行吸附痰液，并根据临床观察情况予以护理。 结果 封闭式吸痰管有利于减轻患者肺部并发症、降低吸痰所引起的血液动力学的改变、防止交叉感染，减轻了护士工作量及提高了护理质量。 结论 封闭式吸痰管适用于气管切开患者的临床应用与推广。

Real-time Ultrasound-guided Percutaneous Dilatational Tracheostomy for Patients after Cardiac Surgery

ObjectiveTo evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. MethodsFrom July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. ResultsAll PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. ConclusionReal-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.

气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用

目的观察气道廓清技术对脑卒中相关性肺炎气管切开患者的临床疗效。方法将 60 例脑卒中相关性肺炎气管切开患者按随机数字表法分为观察组和对照组。观察组在常规治疗的基础上给予气道廓清技术排痰，对照组给予常规治疗和传统体位引流排痰。记录患者体温、外周血白细胞计数、排痰量、气体交换指数及胸部 X 线片浸润情况，比较组间临床肺部感染评分（CPIS）、气管套管拔管时间、拔管成功率及临床疗效的差异。结果干预第 2、3 周后，观察组的 CPIS 评分较对照组均明显降低（P<0.05）；干预第 4 周后，观察组的 CPIS 评分较对照组显著降低（P<0.01）；与干预前相比，从第 2 周开始，随着干预周数的增加，观察组 CPIS 评分降低越显著（P<0.01），而对照组至第 4 周 CPIS 评分才显著降低（P<0.01）。干预 4 周结束后，观察组显效 23 例，有效 6 例，无效 1 例；对照组显效 13 例，有效 16 例，无效 1 例，组间差异有统计学意义（P<0.05）。干预后观察组患者拔管成功率明显高于对照组（P<0.05），观察组拔管时间比对照组显著缩短（P<0.01）。结论气道廓清技术能有效减少脑卒中相关性肺炎气管切开患者痰液，改善患者的缺氧症状，有利于缩短拔管时间，减少并发症的发生，提高拔管成功率，促进患者的康复。

Clinical evaluation of PercuTwist

Objective To compare the advantages and disadvantages of the PercuTwist technique．Methods Clinical data of patients undergoing PercuTwist and traditional tracheostomy during Jan 2007 to Feb 2008 in the department of pulmonary disease of Changhai Hospital were collected and analyzed．Results Of 16 patients with PercuTwist，12 were males and 4 were females．The minimum platelet before operation was 15 X 109／L The mean operating time f from local anesthesia to connecting ventilator)was(4.3±1.0)min，and complications occurred in 2 cases with 2 incidences．Of the 12 patients with traditional tracheostomy，8 were males and 4 were females．The minimum platelet before operation was 85 X 109／L．The mean operating time was(33.3±8.6)min，and complications occurred in 8 cases with11 incidences．There were significant differences in complications and operating time between the patients with PercuTwist and the patients with traditional tracheostomy(P lt;0.001 or 0.01)．Conclusions Compared with the traditional surgical tracheostomy，the PercuTwist technique takes less operating time and causes fewer complications．

Artificial Airway Management for Inhalation Injury Patients Undergoing Tracheotomy

ObjectiveTo summarize the experiences of artificial airway management for inhalation injury patients undergoing tracheotomy. MethodsA retrospective analysis was made on the clinical data of 16 patients with inhalation injury who accepted artificial airway implantation after tracheotomy from January 2012 to October 2014. Certain measures were taken for the patients such as timely sputum suction in a correct way, effective airway moist, timely airway lavage, strict aseptic operation, reasonable position management, dynamic observation and health education. ResultsFifteen patients were cured, and one died. Among the cured patients, there were one case of catheter change due to blocked sputum, and one case of catheter outward portion sliding depth adjusting. ConclusionStrengthening artificial airway management after tracheotomy is the key to keep airway unobstructed, to prevent complications, and to guarantee the safety and a speedy recovery of patients.

经皮微创气管切开时机对危重病患者预后影响的比较

目的 研究经皮气管切开时机与危重病患者预后的关系。方法 按照平行对照设计原理, 将70 例入住重症加强治疗病房( ICU) 需要行机械通气的患者按经皮气管切开时间早晚分为早期组( 机械通气后3 d 内行气管切开) 和晚期组( 机械通气10 d 后行气管切开) 。对两组患者入院 28 d脱机时间、成功脱机率、ICU转出率、呼吸机相关性肺炎( VAP) 发生率进行比较。结果 与早期组患者比较, 晚期组患者28 d 脱机时间显著减少[ ( 6. 13 ±0. 92) d 比( 10. 64 ±1. 47) d] , 成功脱机率显著下降( 54. 3% 比71. 4% ) , ICU转出率显著下降( 48. 6% 比65. 7% ) , VAP发生率显著增加[ 48. 6% 比28. 6% ] ( P 均lt;0. 05) 。结论 早期经皮气管切开可以增加入院28 d 脱机时间、成功脱机率和 ICU转出率, 降低VAP发生率, 改善危重病患者的预后。

两种气管切开导管抽吸囊上积液对机械通气患者影响的比较

【摘要】　目的　比较两种气切导管抽吸囊上积液对机械通气患者的影响。　方法　2007年10月-2008年6月收集60例气管切开患者，随机分为试验组及对照组各30例，试验组使用冲洗式气管切开导管，对照组使用普通气管切开导管，采用不同的方法抽吸囊上积液，分别记录抽吸前、抽吸时和抽吸后心率、血压、血氧饱和度，观察并记录患者舒适度的变化。　结果　抽吸时生命体征试验组优于对照组（Plt;0.05）；抽吸后血压、血氧饱和度试验组优于对照组（Plt;0.05）；舒适度方面试验组优于对照组，试验组有1例发生刺激性呛咳（3.3%），对照组有12例发生刺激性呛咳（40%）。　结论　冲洗式气管切开导管行囊上积液抽吸对患者生命体征影响较小、舒适度高，可广泛使用。

气管切开术后迟发性出血致死亡一例及文献回顾

Influence of different withdrawal time of trachea cannula on percutaneous dilational tracheostomy in critically ill patients

Objective To explore the influence of different withdrawal time of trachea cannula on percutaneous dilational tracheostomy (PDT) in critically ill patients. Methods In this study, we retrospectively analyzed the clinical data of 185 critically ill patients experienced PDT, who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University from January 2015 to July 2017. The patients were divided into an early PDT group (EPDT group) and a delayed PDT group (DPDT group) according to the timing of withdrawing trachea cannula. Operation information such as operation time, blood loss and the incidence of complications were collected and compared between the two groups. Results Between the EPDT group and the DPDT group, there were no obvious differences in operation time (minutes: 6.5±2.6 vs. 7.3±3.5), amount of blood loss (ml: 5.2±2.8 vs. 6.0±3.4) or conversion to traditional operation (1.9% vs. 2.4%) (all P>0.05). Compared with the EPDT group, the DPDT group patients experienced more fluctuation of intraoperative vital signs, used more dose of sedative and analgesic drugs, and experienced higher occurrence of aspiration (18.3%vs. 5.6%), balloon burst (13.4% vs. 2.9%), guide-wire placing difficulty (11.0% vs. 1.9%) and tracheostomy cannula placing difficulty (14.6% vs. 2.9%) (all P<0.05). There were no statistical significances in postoperative complications such as postoperative-hemorrhage, pneumothorax, pneumoderm, the posterior tracheal injury or incision infection between the two groups (allP<0.05). More patients acquired postoperative pulmonary infection in the DPDT group than the EDPD group (12.2%vs. 5.8%, P>0.05), and there was no statistical significances in mechanical ventilation time between the two groups (days: 5.5±3.0vs. 6.0±2.5, P>0.05). Conclusions The operation and complications of PDT in critically ill patients are influenced by the timing of withdrawing trachea cannula. The standard procedure of withdrawing trachea cannula preoperatively may offer better clinical operability and lower technical risk.