心内直视瓣膜置换术后患者气管再插管原因分析和护理  

Analysis of the Re-intubation on Patients with Valve Replacement after Open Heart Surgery and Nursing

作　　者：冯旭琴[1] 赵旭毅[1] 

机构地区：[1]山西省人民医院,山西太原030012

出　　处：《山西职工医学院学报》2012年第3期61-63,共3页Journal of Shanxi Medical College for Continuing Education

摘　　要：目的:分析心内直视瓣膜置换术后患者再次气管插管的原因及护理,以避免气管插管并发症,降低术后死亡率,缩短ICU时间,节约医疗费用。方法:回顾性分析1991年11月至2010年11月间650例心内直视手术后17例2次或以上气管插管患者的临床资料。结果:再次气管插管占同期手术患者的1.29%。再次插管时间为自拔管后1～13 h。17例中,拔管后呼吸无力8例,血流动力学不稳定5例,意外拔管1例,心脏恶液质2例,合并重症肌无力1例。2次插管后顺利脱机10例(58.8%),气管切开后脱机5例(29.4%),死亡2例(11.8%)。结论:严格掌握拔管指征、避免脱机失败、实施程序化脱机是降低再插管发生率和死亡率的关键。Objective：To analyze the reasons and nursing measure for multiple endotracheal intubation on the pa- tients with valve replacement after open heart surgery to prevent complications of endotracheal intubation, lower postop- erative mortality, shorten ICU stay time and save medical costs. Methods： The clinical data of 17 cases among 650 pa- tients who experienced endotracheal intubation 2 times or more were retrospectively analyzed from Oct. 1991 to Nov. 2010 after cardiac surgery. Results： 17 patients of repeated endotracheal intubation accounted for 1.29% of the patients in the same period with 1 hr to 13 hr re-intubation time. Of 17 cases, the breathe inability after extubation was 8 cases, hemodynamic instability in 5 cases, accidental extubation in 1 case, cardiac cachexia in 2 cases and myasthenia gravis in 1 case. Weaning successfully was in 10 cases （58.8%） and 5 cases （29.4%） was successfully weaning from venti- latory support after tracheotomy. There were 2 cases of death （ 11.8 % ）. Conclusion： It is the key to the decrease of the incidence of re-intubation and mortality to control strictly extubation indication, correct the reasons for the weaning fail- ure, and perform weaning procedure.

关 键 词：心内直视瓣膜置换术 气管再插管 护理 

分 类 号：R437.54[医药卫生—临床医学]