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新生儿气胸课件_1

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新生儿气胸ppt 新生儿气胸1
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单击此处编辑母版标题样式 单击此处编辑母版副标题样式 *1 新生儿气胸 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 目录 了解气胸病因及分类 掌握气胸临床表现 掌握气胸治疗及护理 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 定义: 气胸:气体进入胸膜腔,造成积气状态 发生率占新生儿的1%-2%,但具有临床症状者仅为0.05% -0.07%,其发病率在肺透明膜病中为27%,胎粪吸入中占 41%,窒息患儿为25%,湿肺为10% With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 新生儿气胸分类 1 ) 医源性气胸 2)病理性气胸 3 ) 自发性气胸 系指由诊断和治疗操作所致的气胸。临床 类型可分为闭合性气胸,交通性气胸和张 力性气胸 指发生在有基础疾病的新生儿 发生在无基础疾病的新生儿 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 医源性气胸多发生于重度窒息、胎粪吸入综合征 并呼吸衰竭的患儿 在气囊加压给氧,或给氧、气 管插管复苏或机械通气的过程中发生 病理性气胸以肺部疾病为主,是由于肺部本身的 疾病所致,多见于足月儿,常有宫内窘迫或生后 窒息史 自发性气胸是指在无外伤或人为因素的情况下肺 组织及胸膜发生破裂,引起气胸的新生儿 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 1)经窒息复苏后持续呼吸困难,给氧不能缓解,或 突然(或原发病稳定后)出现的呼吸困难、呻吟、 烦躁不安; 2)有部分患儿无明显症状或仅表现为呼吸急促,查 体可有不同程度的呼吸困难、紫绀 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 3)患侧胸廓隆起,肋间隙饱满,叩诊呈过清音,听 诊呼吸音减弱或消失; 4)极少部分患儿无任何呼吸道症状,仅在胸片检查 时发现;有原发病的患儿还有相应原发病的表现 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 • X线 为诊断气胸最可靠的方法。可显示肺压缩 的程度,肺部情况,有无胸腔积液以及纵隔移位 等。 • X线表现:外凸弧形的细线条形阴影,系肺组织 和胸膜腔内气体的交界线,线内为压缩的肺组织 ,线外见不到肺纹理,透亮度明显增加。气胸延 及下部则肋膈角显示锐利。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 • 实验室检查: 血气分析:显示PaO2降低,二氧化碳分压增大 透照试验:以高强度纤维光源两侧对比探查胸部 ,大量气体积聚部位透亮度高 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 • 保守治疗 症状轻、无明显呼吸困难、气胸量 30% 的闭合性气胸经保守治疗后多可治愈。气 胸量为30%时,24-48小时左右可吸收 • 吸氧 高流量吸氧可加速气体的吸收和肺复张。其 机制为:提高血中氧分压,使氮气分压下降,从而增 加胸膜腔与血液间的氮气分压差,促进胸膜腔內氮 气向血液转运,而氧气则可为组织利用而吸收,从而 促进肺复张。 •￿ 吴本清 ,新生儿危重症监护诊疗及护理, 第1版,北京 ,人民卫生出版社 ,2009 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 胸腔穿刺排气-- 适用于出现呼吸困难症状或肺压缩在30%以上 胸腔闭式引流--- 气胸压迫呼吸者 单侧气胸肺压缩在30%以上 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔穿刺及闭式引流 一、做好穿刺前的准备工作: • 1)准备好麻醉药品和穿刺包 • 2) 固定患儿体位; • 3) 在胸腔穿刺过程中,配合医生做好抽气 • 4) 要严密防止穿刺针脱落,保证各管道紧密连接 。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔穿刺及闭式引流 • 胸腔穿刺,一是明确诊断,二是对闭合性气胸抽 气治疗 • 气胸穿刺引流选锁骨中线第2~3肋间 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔穿刺及闭式引流 二、做好穿刺中的配合监督工作 • 1)整个操作严格无菌程序,以防止继发感染,穿 刺引流处应以无菌纱布或无菌敷贴覆盖 • 2)引流管伸入胸腔深度不宜超过4~5cm • 3)注意保持引流管畅通,不使其受压或扭曲 • 4)引流瓶置于病床下不易被碰倒的地方 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 气胸患儿护理 一、气胸的预防 有无呼吸困难或呼吸困难加重、对氧需求增加、 突然持续性发绀、血压下降、局部胸廓不对称、 呼吸音减低、心音遥远低钝 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 气胸患儿护理 二、一般护理 • 尽量减少操作,保持安静,必要时给予苯巴比妥 或水合氯醛镇静,避免哭闹 • 操作尽量集中进行 • 严密监护心率、呼吸、经皮血氧饱和度,24 h出 入液量,定时监测血压,动态监测血气分析,必 要时X线胸片随访。 • 积极治疗原发病,应用抗生素控制感染。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 气胸患儿护理 三、吸氧 • 遵医嘱予头罩或面罩吸氧,正确调节吸入氧浓度 ,以提高动脉血氧含量,加快间质氮气排出,从 而促进气肿吸收,但应注意氧中毒。经常检查, 防止扭曲,保证氧气供应 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 气胸患儿护理 四、机械通气 • 监测血气分析,若病情不稳定,需要多次取血, 可经动脉留置针取血,减少对患儿的刺激。 • 机械通气过程中,尽量以最低的通气压力、最低 的吸入氧浓度,维持血气在正常范围 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔闭式引流护理 一、保持管道的密闭 1)随时检查引流装置是否密闭及引流管有无脱落 2)水封瓶长玻璃管没入水中1~2cm,并始终保持直立 3)移动患儿或更换引流瓶时,需双重夹闭引流管,以防空气 进入 4)引流管连接处脱落或引流瓶损坏,应立即双钳夹闭胸壁引 流导管,并更换引流装置 5)若引流管从胸腔滑脱,立即用手捏闭伤口处皮肤,消毒处 理后,用凡士林纱布封闭伤口,并协助医师做进一步处理 。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔闭式引流护理 二、 严格无菌操作,防止逆行感染 1)引流装置应保持无菌 2)保持胸壁引流口处敷料清洁干燥,一旦渗湿,及时更换 3)引流瓶应低于胸壁引流口60cm,以防瓶内液体逆流入胸 膜腔 4)按规定时间更换引流瓶,更换时严格遵守无菌操作规程。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔闭式引流护理 三 、保持引流管通畅 四、观察和记录 1)注意观察长玻璃管内的水柱波动。 2)观察引流液体的量、性质、颜色,并准确记录 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔闭式引流护理 五、拔管 • 一般引流48~72h后,临床观察无气体溢出,X线 示气胸已复张,夹闭引流管24小时后再次复查胸 片,若X线胸片示肺膨胀良好无漏气,患儿无呼 吸困难表现,即可拔管。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 胸腔闭式引流护理 • 护士协助医生拔管,在吸气末迅速拔管 • 拔管后注意观察患儿有无胸闷、呼吸困难、切口 漏气、渗液、皮下气肿等,如发现异常应及时通 知医师处理。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 感 谢 聆 听
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