气管异物是常见的凶险性意外事故,据统计,7岁以内儿童多见,尤其以刚学会走路到两岁间的小儿发病多,死亡率高。成年人中也偶有病例,多由于饮酒过度、进食时谈笑、工作中将异物含在口内误吸、假牙掉入呼吸道等原因造成。异物首先被吸入喉室内,因刺激黏膜而产生剧烈呛咳、气急等症状,继而出现喉鸣、吸气时呼吸困难、声嘶等表现,在吸气时发出很响的“吼吼……”声,如果异物堵塞声门,或引起喉痉挛,可出现口唇、指甲青紫、面色苍白等缺氧症状。患者会在数分钟内因窒息缺氧而死亡。而在这种意外发生时,及时采取一定的急救措施是至关重要的,患者能够得救也许就在这短短的几分钟里。
现场急救最为理想的办法是美国医学会推荐的海利希手法。海利希手法适用于自救,也可用于互救。
站位急救法 救护者站在患者身后,用双臂围绕患者腰部,一手握拳,拳头的拇指侧顶在患者的上腹部(脐稍上方),另一手握住握拳的手,向上、向后猛烈挤压患者的上腹部,挤压动作要快速,压后随即放松。或抢救者站在患者侧后,一手臂置于病人胸部,围扶病人,另一手掌根在肩胛间区脊柱上给予连续、急促而有力的四次拍击,以利异物排出。
卧位急救法 患者仰卧,救护者两腿分开跪在患者大腿外侧的地面上,双手掌叠放在患者脐稍上方,向下、向前快速挤压,压后随即放松。或让病人屈膝蜷身,面向抢救者,而抢救者用膝和大腿抵住病人胸部,用掌根在肩胛间区脊柱上连续有力四次拍击,使异物排出。
儿童急救法 让患儿俯卧在两腿间,头低脚高,然后用手掌适当用力在患儿的两肩胛骨间拍击4次。拍背不见效,可让患儿背贴于救护者的腿上,然后救护者用两手食指和中指用力向后、向上挤压患儿中上腹部,压后即放松,可重复几次。或使用催吐法,用手指伸进口腔,刺激舌根催吐,此法适用于较靠近喉部的气管异物。若上述方法未能奏效,则应立即将患者送医院急救,在喉镜或气管镜下取出异物,切不可拖延。呼吸停止的即给予口对口人工呼吸,以期为抢救争取时间。
有些较小的异物呛入气管后,患者一阵呛咳后,并没有咳出任何异物,却很快平静下来。说明异物已进入支气管内,支气管异物可能没有任何明显的呼吸障碍。但绝不可麻痹大意、心存侥幸,认为异物迟早总会咳出,因为异物一旦进入支气管,被咳出的机会是极少的。异物在肺内存留时间过长,不仅不易取出,还可引起支气管肺炎、肺不张、肺脓肿等严重疾病,影响肺功能。所以,凡是明知有异物呛入气管,在没有窒息的情况下,即使没有任何呼吸障碍表现,也应尽早去医院行胸部CT等检查,以便在气管镜下取出异物。
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