MDT+远程会诊：84岁气切老人三周重获自由呼吸
<!----><style type="text/css">html{font-size:375%}</style><link href="https://pic.app.jiuquhe.com/static/publish/css/style.css?v=20240712" rel="stylesheet" position="1" data-qf-origin="/static/publish/css/style.css?v=20240712"><!-- 付费贴--> <div class="preview_article "> <!----> <section style="font-size: 16px; font-family: Optima-Regular,PingFangTC-Light,微软雅黑;"><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">84岁，车祸重伤，三次手术，十四项诊断，三根管路——当这些沉重的标签同时压在一位84岁老人身上时，几乎所有人都在心底打上了问号：他还能顺利拔管吗？</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">在资阳市第四人民医院呼吸内科的系统施治下，在四川大学华西天府医院呼吸与危重症医学科呼吸康复专家团队的指导下，老人仅用三周时间，实现了气管切开导管、鼻胃管、尿管“三管全拔”，重获自由呼吸。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><section><section style="margin: 10px auto; display: flex; justify-content: center;"><section><section style="font-size: 20px; text-align: center; background-image: linear-gradient(to top, #ffffff,#fefdfa 30%, #d7e3bc 70%); background-clip: text; -webkit-background-clip: text; -webkit-text-fill-color: transparent; margin-bottom: -8px;"><strong>0</strong><strong>1</strong></section><section style="display: flex; justify-content: center; align-items: center;"><section style="background: linear-gradient(to right,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section><section style="flex-shrink: 0;"><section style="font-size: 16px; color: #72ac26; text-align: center; padding: 0 5px; box-sizing: border-box;"><strong>至暗时刻：气切拔管，何其艰难</strong></section></section><section style="background: linear-gradient(to left,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">两个月前的一场车祸，让这位耄耋老人遭受脾脏破裂、腹腔出血、寰椎骨折、胸腰椎骨折、多根肋骨骨折、肺挫伤等多处重伤。急诊手术后，命虽保住，但气管切开导管、鼻胃管、尿管三根管道将他牢牢禁锢在病床上。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">转入我院时，诊断多达14项：脑外伤后遗症、气管切开术后拔管困难、多处骨折、肺挫伤、下肢静脉血栓、低蛋白血症……氧合指数仅182，处于呼吸衰竭状态，伴有肌肉萎缩及重度营养不良等多种并发症。更棘手的是，老人因失能而情绪暴躁，打家属和医务人员，拒不配合治疗。家属们愁容满面，所有人都知道——拔管，太难了。</p><section><section style="margin: 10px auto; display: flex; justify-content: center;"><section><p style="text-align: center; font-size: 20px; background-image: linear-gradient(to top, #ffffff,#fefdfa 30%, #d7e3bc 70%); background-clip: text; -webkit-background-clip: text; -webkit-text-fill-color: transparent; margin-bottom: -8px;"> </p><p style="text-align: center; font-size: 20px; background-image: linear-gradient(to top, #ffffff,#fefdfa 30%, #d7e3bc 70%); background-clip: text; -webkit-background-clip: text; -webkit-text-fill-color: transparent; margin-bottom: -8px;"><strong>0</strong><strong>2</strong></p><section style="display: flex; justify-content: center; align-items: center;"><section style="background: linear-gradient(to right,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section><section style="flex-shrink: 0;"><section style="font-size: 16px; color: #72ac26; text-align: center; padding: 0 5px; box-sizing: border-box;"><strong>多学科团队集结，华西云端助力</strong></section></section><section style="background: linear-gradient(to left,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><section><section style="margin: 10px auto;"><section style="background: linear-gradient(to right, #92c06a, #ffffff 60%); padding: 4px 15px 30px; box-sizing: border-box; height: 34px;"></section><section style="background-color: #fffffe; padding: 6px; box-shadow: #d9d9d9 1px 1px 2px,#d9d9d9 -1px 1px 2px,#d9d9d9 0px 1px 3px; margin: -24px 15px 3px; box-sizing: border-box;"><section style="width: 100%; max-width: 100% !important; box-sizing: border-box;"><img class="rich_pages wxw-img" style="width: 100%; display: block; vertical-align: baseline; box-sizing: border-box; max-width: 100% !important;" src="https://pic.app.jiuquhe.com/20260807/17860961349782123895.jpeg" /></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">面对这一难题，呼吸内科立即启动多学科协作（MDT）团队，联合老年疾病科、康复医学科、心身障碍科、营养科进行全面评估。同时特邀四川大学华西天府医院呼吸与危重症医学科呼吸康复团队开展线上个案讨论，为老人量身定制了个性化康复方案。康复团队以"三步走"策略，科学推进气切导管拔除进程：</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">第一步：<strong>夯实基础，为拔管蓄力。</strong>呼吸科规范开展气切护理、气道湿化与体位管理；呼吸康复师进行四肢被动训练对抗肌肉萎缩、诱导咳嗽训练唤醒呼吸肌；营养科定制高营养膳食方案纠正低蛋白血症；心理科药物干预与情绪疏导同步，鼓励家属陪伴，稳定老人情绪，重建康复信心。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">第二步：<strong>优化气道，向拔管迈进。</strong>果断将已有痰痂形成的塑料导管更换为金属导管，显著改善通气、降低感染风险。同步升级康复方案——机械辅助排痰、体外膈肌起搏治疗、呼吸训练多管齐下，逐步提升呼吸肌力量，老人精神状态随之好转。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">第三步：<strong>冲刺拔管，见证关键一刻。</strong>氧合指数飙升至469，咳嗽效力显著增强，吞咽功能恢复。团队按气切康复专业路径，每日2—3次呼吸肌抗阻训练强化呼吸功能，每日2次发声训练让老人重拾言语能力，摄食训练从一滴温水到一勺糊状食物逐步递进，为拔除气切导管和鼻胃管做最后准备。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><section><section style="margin: 10px auto;"><section style="background: linear-gradient(to right, #92c06a, #ffffff 60%); padding: 4px 15px 30px; box-sizing: border-box; height: 34px;"></section><section style="background-color: #fffffe; padding: 6px; box-shadow: #d9d9d9 1px 1px 2px,#d9d9d9 -1px 1px 2px,#d9d9d9 0px 1px 3px; margin: -24px 15px 3px; box-sizing: border-box;"><section style="width: 100%; max-width: 100% !important; box-sizing: border-box;"><img class="rich_pages wxw-img" style="width: 100%; display: block; vertical-align: baseline; box-sizing: border-box; max-width: 100% !important;" src="https://pic.app.jiuquhe.com/20260807/17860961364139218456.jpeg" /></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><section><section style="margin: 10px auto; display: flex; justify-content: center;"><section><section style="font-size: 20px; text-align: center; background-image: linear-gradient(to top, #ffffff,#fefdfa 30%, #d7e3bc 70%); background-clip: text; -webkit-background-clip: text; -webkit-text-fill-color: transparent; margin-bottom: -8px;"><strong>0</strong><strong>3</strong></section><section style="display: flex; justify-content: center; align-items: center;"><section style="background: linear-gradient(to right,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section><section style="flex-shrink: 0;"><section style="font-size: 16px; color: #72ac26; text-align: center; padding: 0 5px; box-sizing: border-box;"><strong>气切导管拔出：那一声“能说话了”</strong></section></section><section style="background: linear-gradient(to left,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">循序渐进的科学康复，终换来圆满结果。团队依次拔除老人尿管、胃管，最后迎来最关键的一步——气切导管拔出。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">当气切导管被拔出的那一刻，老人深吸一口气，用久违的声音说出一句：“能……说话了。”</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">从氧合指数极低、呼吸岌岌可危，到呼吸平稳、心肺功能稳定；从暴躁抵触、身心俱疲，到心态平和、主动配合康复；从三管缠身、卧床失能，到自主坐立、吃饭、说话——短短三周，没有惊天动地的奇迹，只有精准专业的医疗技术、循序渐进的康复体系、温柔坚守的人文关怀。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><section><section style="margin: 10px auto; display: flex; justify-content: center;"><section><section style="font-size: 20px; text-align: center; background-image: linear-gradient(to top, #ffffff,#fefdfa 30%, #d7e3bc 70%); background-clip: text; -webkit-background-clip: text; -webkit-text-fill-color: transparent; margin-bottom: -8px;"><strong>0</strong><strong>4</strong></section><section style="display: flex; justify-content: center; align-items: center;"><section style="background: linear-gradient(to right,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section><section style="flex-shrink: 0;"><section style="font-size: 16px; color: #72ac26; text-align: center; padding: 0 5px; box-sizing: border-box;"><strong>给气切拔管困难患者及家属的建议</strong></section></section><section style="background: linear-gradient(to left,#ffffff,#92c06a); width: 3em; height: 7px; box-sizing: border-box;"><section style="width: 100%; height: 2px; background-color: #ffffff; margin-top: 4px; max-width: 100% !important; box-sizing: border-box;"></section></section></section></section></section></section><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">1、<strong>尽早评估拔管可能：</strong>原发病稳定后，应尽快由专业团队进行呼吸、吞咽、气道全面评估，把握拔管黄金窗口。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">2、<strong>呼吸康复介入越早，拔管成功率越高：</strong>呼吸肌训练、气道廓清、吞咽训练，每一步都有科学依据。研究显示，脑损害气管切开患者中，早期拔管组的成功率显著优于传统组。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">3、<strong>不要因</strong><strong>“</strong><strong>不配合</strong><strong>”</strong><strong>而放弃：</strong>老人可能因恐惧焦虑而抵触，需要家属耐心陪伴，更需要专业的心理支持。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">4、<strong>拔管不是终点：</strong>回归正常生活才是最终目标。拔管后仍需坚持康复训练，巩固治疗效果。</p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;"> </p><p style="text-align: justify; margin: 4px 0px; line-height: 1.75; font-weight: 400; color: #333333; text-shadow: none; letter-spacing: 1.5px; font-size: 14px;">从“三管缠身”到自由呼吸，这根气切导管的拔出，不仅是一次成功的医疗操作，更是多学科协作模式与远程会诊机制协同发力的生动缩影。资阳市第四人民医院呼吸内科，以专业破解难题，以温情守护生命——给绝望者以希望，让不可能成为可能。</p></section><p style="display: none;"> </p> <!----></div> 点赞点赞
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