【概 述】 1.概念
直径大于2mm的支气管 管壁的肌肉和弹性组织破坏 慢性持久异常扩张 临床特点
慢性咳嗽 大量脓痰 反复咯血
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（二）身体状况
1.慢性咳嗽、大量脓痰
量：可达数百毫升，与体位有关 色：黄色或绿色 静置分三层：上层：泡沫；
中层：粘液； 下层：坏死组织
合并厌氧菌感染可有恶臭味
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（四）辅助检查
1.影像学检查 ：X线胸片 胸部CT 支气管碘油造影
2.纤维支气管镜检查
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【护理问题】
1.清理呼吸道无效 与痰液黏稠和无效咳嗽 有关
2.有窒息的危险 与痰多、痰液黏稠或大咯 血造成气道阻塞有关
3.营养失调（低于机体需要量） 与反复感染 导致机体消耗增加பைடு நூலகம்关
4.恐惧 与突然或反复大咯血有关
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
支气管扩张病人的护理 护理业务学习 呼吸一科2013-3月
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
病理
感染和支气管阻塞互为因果 易发部位：炎症性多见于下叶、左下叶
肺结核多见于上叶 支扩特点：柱状和囊状扩张 毛细血管扩张、动脉瘤形成导致反复咯血
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【护理评估】
（一）健康史
-幼儿时期麻疹、百日咳、支气管肺 炎、呼吸道感染反复发作史 -异物、肿瘤、肺结核 病史 -先天发育缺陷 -免疫功能失调性疾病
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（二）病情观察
咳痰、咯血的颜色、性质、量 生命体征 窒息的先兆 发现窒息先兆立即报告医生，配合抢救
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
体位引流
原理：重力使痰液从支气管→气管→体外 准备：解释 体位：病变部位 用药：抗生素、化痰药物 时间：饭前，1-3次/天；15-20分钟/次 观察：脸色、脉搏、眩晕等症状
引流后护理：舒适体位；口腔护理；引流效果
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【护理措施】
（一）一般护理
1．大咯血绝对卧床，患侧卧位 2．高热量、高蛋白、高维生素饮食,
每天饮水1500ml以上
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（三）心理-社会状况 焦虑、沮丧 自卑、孤独、回避 恐惧
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（三）促进排痰的护理
指导有效咳嗽 体位引流 遵医嘱用祛痰剂或β2受体激动剂
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
（五）治疗要点
原则：保持呼吸道引流通畅
控制感染
处理咯血
必要时手术治疗
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
实验室检查： 血常规：WBC N 痰涂片和痰培养:致病菌
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
2.病因
气管-肺感染和支气管阻塞:婴幼儿百日咳、
麻疹、支气管肺炎、肿瘤、异物吸入
先天发育缺陷、遗传因素：巨大气管-支气
管症、肺囊性纤维化
30%病因不明可能是机体免疫功能失调
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
5.体征
早期或干性支气管扩张无异常肺部体征 典型肺部体征可听到固定持久的湿罗音 有气道痉挛或狭窄时可听到哮鸣音 慢性者可见到杵状指（趾） 营养不良、贫血等体征
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians