新型冠狀病毒病患呼吸器使用的感染控制及拔管後使用高流量氧氣鼻導管之呼吸照護經驗

Abstract

嚴重特殊傳染性肺炎是受嚴重急性呼吸系統症候群冠狀病毒 2 型(severe acute respiratory syndrome coronavirus 2, SARS-CoV-2)所感染而引發的肺炎,嚴重特殊 傳染性肺炎重症患者常會導致呼吸衰竭,機械通氣是發生嚴重呼吸衰竭的患者最有 效的治療策略之一。本個案是因感染嚴重特殊傳染性肺炎導致低血氧性呼吸衰竭因 而插管使用侵襲式呼吸器,照護過程中,侵襲式呼吸器的管路和相關的零組件可能 成為主要的污染源,因此,如何在使用侵襲式呼吸器的過程中同時保護醫護人員與 病患的安全,以及在拔管後該如何善用侵襲式呼吸器以外的治療策略來縮短病患使 用侵襲式呼吸器的時間與預防病患重插管率,就顯得十分重要。因此,本個案報告 主要是在探討使用呼吸器時的感染控制與拔管後使用高流量鼻導管氧氣治療於嚴重 特殊傳染性肺炎病患之治療策略及氧合療效。  Severe pneumonia with novel pathogens presents as pneumonia caused by the infection of severe acute respiratory syndrome coronavirus type 2 (SARS- CoV-2). Severe pneumonia with novel pathogens often leads to respiratory failure, and mechanical ventilation is one of the most effective treatment strate- gies for patients who are suffering from severe respiratory failure. In this case, mechanical ventilation was used due to severe pneumonia with novel pathogens leading to hypoxic respiratory failure. However, the ventilator circuit and related components of the ventilator may become the main source of pollution. There- fore, preventing infection when using a ventilator to protect the safety of medical staff and patients, and making good use of treatment strategies after extubation to prevent patients from reintubation are very important. As a result, this case report mainly discusses infection control during the use of ventilators and treat- ment strategy and oxygenation efficacy of high flow nasal cannula in patients with severe and severe pneumonia with novel pathogens after extubation.