摘要
气管切开是危重患者救治过程中常用的措施,以便实施机械通气、改善气道通畅性或进行气道内操作等。气管切开患者如得不到规范管理,易导致相关并发症。合理的气管切开术前术后管理措施与康复治疗将有利于降低气管切开的并发症、早期拔除气管切开套管、降低总的死亡风险或提高长期留置气管切开套管患者的生活质量。基于气管切开患者的病理生理及临床特征,形成气管切开管理及其康复治疗的规范流程,指导临床工作,具有重要的临床意义。由中国医学装备协会呼吸病学装备专业委员会、中国残疾人康复协会肺康复专业委员会中青年肺康复专业学组、中国康复医学会危重症康复学组的有关专家组成的撰写专家组,通过文献检索和专家组的反复讨论,形成本专家推荐意见,为临床实践提供参考。
Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation.Tracheostomies have several advantages over endotracheal tubes,including less sinusitis or pharyngeal injuries,fewer sedative drugs,improved oropharyngeal hygiene,easier communication,more comfort,preservation of vocal cord function,and so on.However,patients with a tracheostomy require high quality care and often suffer from dysphagia,dysphonia,tracheal stenosis,or excessive airway secretions,etc.In China,there are currently no comprehensive evidence-based clinical guidelines or consensus documents on the management and rehabilitation of patients with a tracheostomy.Approaches to tracheostomy care are inconsistent among different institutions and clinicians.Therefore,a group of top experts specialized in this field in China were gathered to draft this document to reduce variations in practice in the management of patients with a tracheostomy and to minimize complications.Panel members were asked to complete surveys on various aspects of adult tracheostomy care,followed by a conference at which the results were presented and a number of themes outlined for a formal literature review and a preliminary draft.Several conferences were then held to discuss the differences of opinion among the panel members.In general,the panel reached a consensus and a total of 9 issues were covered in the document.At first,the importance of a standardized management protocol,pathophysiological characteristics,indications,complications,contradictions,and techniques used for tracheostomies were discussed.Then,more emphasis was placed on post-operative care such as airway clearance therapy,tube changes,and decannulation criteria,etc.In addition,the most important topic was elaborated,namely the methods used to promote the rehabilitation and decannulation of patients with a tracheostomy,including respiratory and other skeletal muscle training,dysphagia and verbal communication intervention,ventilation support,chest physiotherapy,and specifically the traditional Chinese medical therapies that were excellent in this area,such as acupuncture,moxibustion,and herbal medicine,etc.Finally,a flow chart was created to summarize the suggestions for managing and promoting rehabilitation or decannulation of patients with a tracheostomy.Proposed by Respiratory Equipment Committee of China Association of Medical Equipment,Young and Middle-Aged Pulmonary Rehabilitation Group of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Person,and Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine,and sponsored by several national or provincial natural science research projects,this work is expected to provide clear guidance for the general treatment of adult patients with a tracheostomy in China in the future.
作者
中国医学装备协会呼吸病学装备专业委员会
中国残疾人康复协会肺康复专业委员会中青年肺康复专业学组
中国康复医学会危重症康复学组
郑则广
赵红梅
陈荣昌
Respiratory Equipment Committee of China Association of Medical Equipment;Young and Middle-aged Pulmonary Rehabilitation Committee of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Persons;Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2023年第10期965-976,共12页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
重大呼吸系统疾病关键诊疗技术的临床研究和成果转化(2022-NHLHCRE-LY-01)
中国医学科学院医学与健康科技创新工程(2021-I2M-1-056)
首都卫生发展科研专项(2020-34068)
国家重点研发计划(2016YFC1304600)
广东省自然科学基金面上项目(2021A1515012201)
广州市科学技术局市校(院)联合资助项目(202201020435)
深圳市科技研发专项-专2019N007(KCXFZ202002011008256)。
