一个研究的难度在解锁的气管切除术头部损伤患者的患者
Yash Vardhan Dubey1, B K Prasad1
1Command Hospital (CC), Lucknow, UP India.
概括
在 75% 的病例中,通过气管切除术治疗的头部损伤患者的脱术成功. 成功脱的关键因素包括强烈的咳反射和充足的呼吸道,不一定是声声或管道缩小.
科学领域:
- 神经外科 神经外科
- 关键护理医学 关键护理医学
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
背景情况:
- 气管切除术是头部受伤患者常见的手术,需要长时间的机械通风.
- 由于呼吸道问题和神经系统缺陷,脱化可能具有挑战性.
- 在这个群体中缺乏用于脱的标准化协议.
研究的目的:
- 为了分析脱管的困难,气管切除术的头部受伤患者.
- 开发一项可靠的协议,以成功进行脱.
- 确定影响脱结局的因素.
主要方法:
- 对40名经过气管切除术的头部损伤患者 (10-70岁) 的前性观察性研究.
- 评估神经状态 (格拉斯哥昏迷量表),呼吸道充足度,发音,吞,咳反射和肺部病理.
- 管封成功封闭后3天的脱试验.
主要成果:
- 在75%的患者中成功实现了脱.
- 神经状况,呼吸器支持续时间,咳反射,吸气需求,呼吸道分泌的一致性和肺部状况显著影响了脱管成功 (p <0.05).
- 损伤方式,神经外科手术,无声化和管子缩小没有显著影响结果 (p>0.05).
结论:
- 强烈的咳反射,最小的气管分泌物,安全的吞,更高的格拉斯哥昏迷表得分,以及早期的呼吸机断奶有利于成功的断管.
- 声调和逐渐的管子缩小并不是脱管的必要前提.
- 结构化评估协议对于优化头部损伤患者的脱管治疗成功至关重要.
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