Chinese General Practice ›› 2025, Vol. 28 ›› Issue (18): 2193-2204.DOI: 10.12114/j.issn.1007-9572.2024.0686
• Guidelines·Consensus • Next Articles
Received:
2024-12-02
Revised:
2025-03-10
Published:
2025-06-20
Online:
2025-04-25
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2024.0686
生理功能 | 气管切开负面效应 | 语音阀获益 | |
---|---|---|---|
生理获益 | 临床获益 | ||
加温加湿功能 | 丧失 | 部分恢复 | 增强气道保护能力,减少误吸和感染风险,缩短患者机械通气和拔除气管切开导管时间 |
咳嗽功能 | 咳嗽反射减弱 | 提高呼气压力,增强咳嗽反射 | |
吞咽功能 | 受损 | 改善 | |
呼吸功能 | 气道塌陷风险增加,自主呼吸能力受限 | 提升肺功能,增强呼吸肌耐力 | |
发声功能 | 丧失,影响语言发育 | 恢复,改善儿童语言发育 | 促进康复,减少并发症及住院时间,降低医疗成本 |
心理健康 | 无法发声可能引发焦虑、抑郁 | 恢复沟通,缓解心理压力 | |
活动能力 | 受限 | 促进早期活动 |
Table 1 Negative physiological effects of tracheotomy and benefits of speaking valve
生理功能 | 气管切开负面效应 | 语音阀获益 | |
---|---|---|---|
生理获益 | 临床获益 | ||
加温加湿功能 | 丧失 | 部分恢复 | 增强气道保护能力,减少误吸和感染风险,缩短患者机械通气和拔除气管切开导管时间 |
咳嗽功能 | 咳嗽反射减弱 | 提高呼气压力,增强咳嗽反射 | |
吞咽功能 | 受损 | 改善 | |
呼吸功能 | 气道塌陷风险增加,自主呼吸能力受限 | 提升肺功能,增强呼吸肌耐力 | |
发声功能 | 丧失,影响语言发育 | 恢复,改善儿童语言发育 | 促进康复,减少并发症及住院时间,降低医疗成本 |
心理健康 | 无法发声可能引发焦虑、抑郁 | 恢复沟通,缓解心理压力 | |
活动能力 | 受限 | 促进早期活动 |
不良事件类型 | 可能原因 | 处理措施 |
---|---|---|
低氧血症 | (1)患者基础呼吸功能差 (2)气管切开导管过粗、气囊排空或分泌物引流不充分 (3)经口鼻腔吸入空气,降低实际吸入氧浓度 | (1)根据患者情况在气管切开处提供氧气治疗和呼吸支持 (2)严格遵循使用规范,佩戴语音阀前进行吸痰和声门下吸引,并确认气囊充分放气 (3)必要时更换型号较小的气管切开导管 (4)必要时增加口鼻处氧供 |
气道廓清障碍 | (1)呼气相气道阻力增加,降低气道廓清能力 (2)气道分泌物过多 | (1)移除语音阀,充分进行气道内吸引 (2)必要时更换型号较小的气管切开导管 (3)气道分泌物过多的患者不建议佩戴语音阀 |
剧烈咳嗽 | (1)上呼吸道气流刺激 (2)分泌物引发咳嗽 | (1)辅助患者咳痰或进行分泌物吸引 (2)若患者咳嗽持续或表现痛苦,立即移除语音阀并重新评估是否继续应用 |
气道湿化不足 | (1)痰液黏稠 (2)湿化设备选择或设置不当、湿化水不足或设备故障 | (1)使用恰当的湿化设备或调整湿化设置,及时清理痰液 (2)及时补充湿化水 (3)气道分泌物过于黏稠、难以咳出的患者不建议佩戴语音阀 |
误吸 | (1)患者存在误吸风险 (2)语音阀移位而被误吸入气道 | (1)佩戴语音阀前停止进食,保持床头抬高30°~45°,气囊放气前充分吸引口鼻腔及气囊上分泌物,从而降低误吸发生风险 (2)若明确发生误吸,应重新评估患者是否具备佩戴语音阀的条件 (3)对于存在高误吸风险的患者,不建议佩戴语音阀 (4)将语音阀连接到气管切开导管固定带上,预防语音阀被误吸入气道 (5)一旦发现语音阀被误吸入气道,应尽快将其移除 |
气压伤 | (1)气囊未完全放气导致气道内压力升高 (2)操作者对使用规范不熟悉 | (1)气囊处张贴警告标签 (2)床边张贴使用流程 (3)对医护人员定期开展培训 |
其他 | 患者焦虑 | (1)对患者进行全面教育,解释语音阀功能和可能出现的不适 (2)使用分散注意力技术,鼓励社交活动 (3)提供视觉辅助工具帮助练习呼吸和发声 |
Table 2 Causes and management measures of speaking valve-related adverse events
不良事件类型 | 可能原因 | 处理措施 |
---|---|---|
低氧血症 | (1)患者基础呼吸功能差 (2)气管切开导管过粗、气囊排空或分泌物引流不充分 (3)经口鼻腔吸入空气,降低实际吸入氧浓度 | (1)根据患者情况在气管切开处提供氧气治疗和呼吸支持 (2)严格遵循使用规范,佩戴语音阀前进行吸痰和声门下吸引,并确认气囊充分放气 (3)必要时更换型号较小的气管切开导管 (4)必要时增加口鼻处氧供 |
气道廓清障碍 | (1)呼气相气道阻力增加,降低气道廓清能力 (2)气道分泌物过多 | (1)移除语音阀,充分进行气道内吸引 (2)必要时更换型号较小的气管切开导管 (3)气道分泌物过多的患者不建议佩戴语音阀 |
剧烈咳嗽 | (1)上呼吸道气流刺激 (2)分泌物引发咳嗽 | (1)辅助患者咳痰或进行分泌物吸引 (2)若患者咳嗽持续或表现痛苦,立即移除语音阀并重新评估是否继续应用 |
气道湿化不足 | (1)痰液黏稠 (2)湿化设备选择或设置不当、湿化水不足或设备故障 | (1)使用恰当的湿化设备或调整湿化设置,及时清理痰液 (2)及时补充湿化水 (3)气道分泌物过于黏稠、难以咳出的患者不建议佩戴语音阀 |
误吸 | (1)患者存在误吸风险 (2)语音阀移位而被误吸入气道 | (1)佩戴语音阀前停止进食,保持床头抬高30°~45°,气囊放气前充分吸引口鼻腔及气囊上分泌物,从而降低误吸发生风险 (2)若明确发生误吸,应重新评估患者是否具备佩戴语音阀的条件 (3)对于存在高误吸风险的患者,不建议佩戴语音阀 (4)将语音阀连接到气管切开导管固定带上,预防语音阀被误吸入气道 (5)一旦发现语音阀被误吸入气道,应尽快将其移除 |
气压伤 | (1)气囊未完全放气导致气道内压力升高 (2)操作者对使用规范不熟悉 | (1)气囊处张贴警告标签 (2)床边张贴使用流程 (3)对医护人员定期开展培训 |
其他 | 患者焦虑 | (1)对患者进行全面教育,解释语音阀功能和可能出现的不适 (2)使用分散注意力技术,鼓励社交活动 (3)提供视觉辅助工具帮助练习呼吸和发声 |
方向 | 内容 |
---|---|
材料和设计 | 开发新型生物材料来减少细菌定植并延长使用寿命 |
结合各类传感器技术的智能化适应患者呼吸形态 | |
临床使用 | 探讨语音阀临床早期干预时机和标准 |
探索语音阀在不同患者群体中误吸防治效果 | |
研究佩戴语音阀对患者长期生活质量影响 | |
探索包含语音阀的最优化撤机拔管流程 | |
建立语音阀使用的标准化评估体系 | |
团队协作 | 探讨多学科协作管理机制 |
出院随访 | 探索长期家庭应用的远程监控和预警 |
Table 3 Future clinical exploration and research directions for the speaking valve
方向 | 内容 |
---|---|
材料和设计 | 开发新型生物材料来减少细菌定植并延长使用寿命 |
结合各类传感器技术的智能化适应患者呼吸形态 | |
临床使用 | 探讨语音阀临床早期干预时机和标准 |
探索语音阀在不同患者群体中误吸防治效果 | |
研究佩戴语音阀对患者长期生活质量影响 | |
探索包含语音阀的最优化撤机拔管流程 | |
建立语音阀使用的标准化评估体系 | |
团队协作 | 探讨多学科协作管理机制 |
出院随访 | 探索长期家庭应用的远程监控和预警 |
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