1 气道高压报警 气道高压报警最为常见。各种原因使气道压力升高,超过设置压力报警上限时,即触发呼吸机气道压高限报警。 1.1 气道内分泌物过多或阻塞:其发生原因主要有:①吸痰不及时或不充分,以致气道内分泌物过多,影响通气功能,气道阻力增加,引发报警。②气道湿化不足,导致气管黏膜干燥,分泌物结痂,阻塞气道,气道压急剧升高,引起报警。处理方法:如分泌物过多,除积极有效抗感染外,还要加强吸痰次数,使气道始终保持通畅,同时注意无菌操作,减少肺部感染和肺不张的机会。如果气道被黏稠的痰液阻塞,应立即使用有效的吸引技术清除痰液。必要时可用纤维支气管镜吸痰。如痰液黏稠不易吸出时,可用庆大霉素80 kU加糜蛋白酶5 mg加生理盐水100 ml行气道持续湿化或间歇湿化;也可在呼吸机通路上安装雾化吸入装置以达到稀释痰液的作用。 1.2 呼吸通路问题:管道打折、受压、积水等,也可致呼吸机气道高压报警。处理方法:立即排除管道打折和受压原因,清除管道内积水,经常检查。 人机对抗:发生人机对抗的原因主要是患者术后疼痛的刺激,由于手术创伤和术后各种引流管的刺激,在搬动患者时刺激痛觉感受器,通过神经传导引起切口疼痛反应,患者憋气致人机呼吸不同步,引发报警。 处理方法:应及时按医嘱给予止痛、镇静治疗,同时做好患者的心理护理,向患者说明机械通气的重要性,增强其对疾病治疗的信心,取得患者的配合,另外,尽量减少不良因素的刺激。 2 气道低压报警 呼吸机低压报警装置是发现患者脱机的一种保护措施,报警最可能的原因就是患者脱机。患者一般表现为呼吸急促、发绀,咽喉部有漏气声或听到患者说话声。对于气管切开患者,可见气管切开口周围分泌物有气泡出现。 处理方法:①检查气管导管气囊充气情况,必要时重新充气,如气囊破裂应立即更换气管导管。②仔细检查呼吸机管路,更换破裂管道并将各接头接紧,尤其检查容易忽视的接头、集水瓶等。③如果患者出现呼吸急促、发绀等缺氧症状,立即使用简易呼吸器进行人工呼吸。
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