摘要
目的:探讨提高外伤性颈动脉破裂外科救治成功率,总结其护理经验,为临床护理提供理论依据。方法:8例外伤性颈动脉破裂患者在颈部简单压迫止血同时施行气管插管全麻,其中经喉气管裂开处插管2例;口腔插管6例;颈外动脉及分支结扎2例;颈总动脉紧急结扎1例;颈总动脉纵向破裂采用"次半管缝合"修复5例,全组患者行术后低位气管切开。围手术期护理中,配合医生完善各项术前检查;神志清醒者均接受心理疏导,消除不良的心理因素。全部患者术中接受中心静脉压测定和围手术期心电监护仪严密观察患者的生命体征,发现异常及时通知医生并配合处理。术后对术区状况、引流、体位、气管切开、感染、预防并发症等进行讲解和护理。结果:全组病例在全麻下施行颈总动脉修复或/和颈外动脉及分支结扎7例;颈总动脉结扎1例;术中平均失血量700～1000 m L/人,随访4月～5年,除1例颈总动脉紧急结扎者术后偏瘫,于2周后死亡,其余患者均存活,未见脑缺血或栓塞并发症,术区局部感染2例,通过术后精心护理,换药,引流,抗感染处理后痊愈。结论:外伤性颈动脉破裂伤情复杂,病情危重,严重威胁生命,围手术期各项急救护理,严密观察以及术后并发症的预防都是整体救治的重要环节不容忽视。
Objective To study the successful rate of surgical treatment for traumatic carotid artery rupture, summarize the nursing experience, and provide theoretical basis for clinical nursing experience. Methods Eight cases of patients with traumatic carotid artery rupture were carried neck simple compression hemostasis and imposed endotracheal intubation anesthesia at the same time. Including larynx and trachea split, and intubation in 2 cases; oral intubation in 6 cases; and external carotid artery and branches ligation in 2 cases; Common carotid artery ligation in 1 case of emergency; Longitudinal fracture repair of common carotid arteries in 5 cases. The entire group of patients were underwent low postoperative tracheotomy. During perioperative nursing, we cooperated with the doctor to finish the preoperative examination; Sane individual were underwent psychological nursing to eliminate adverse psychological factors. All patients were received the central venous pressure measurement and perioperative ECG monitor closely to observe the patient＇s vital signs. We notified the doctor if it was abnormal and cooperated with the processing. while, we executed explanation and caring for patients on status of postoperative area, drainage, postures, tracheotomy, infection, prevention of complications and so on. Results All cases were underwent general anesthesia, common carotid artery repair and/or part of the external carotid artery and branches ligation in 7 cases; Common carotid artery ligation in 1 case; Average blood loss was 700-1000 ml/individual, among them. Follow-up these patients from 4 months to 5 years, except 1 case of hemiplegia after emergency common carotid arteries ligation, and died after 2 weeks, the other patients were alive, not seen ischemic complications, the area local infection in 2 cases, and it recovered due to careful nursing, postoperative treatment, drainage, anti-infl ammatory treatment after operation. Conclusion Traumatic carotid artery rupture injury, which was complicated,in a critical condition, and a serious threat to life, needed a multidisciplinary joint rescue emergency treatment. Perioperative emergency care, close observation and prevention of postoperative complications were important parts of the overall treatment,and it should not be ignored.
出处
《深圳中西医结合杂志》
2016年第9期138-140,共3页
Shenzhen Journal of Integrated Traditional Chinese and Western Medicine
基金
广东省医学科研基金项目资助课题(A2014151)
