老年腹部手术后肺部并发症患者实施改良俯卧位通气的效果和护理

目的探讨老年腹部手术后并发急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者实施改良俯卧位通气治疗的效果及其护理。方法方便性抽样选择2010年4月至2011年4月我科收治的老年腹部手术后并发ALI/ARDS患者18例,实施改良俯卧位通气,记录治疗前和治疗后1、2h患者心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)以及氧合指数(oxygenation index,PaO2/FiO2)的变化,以观察体位通气治疗对患者循环功能和氧合状态的影响。结果与治疗前相比,改良俯卧位通气治疗后1、2h患者的SpO2、PaO2/FiO2均升高(P<0.01),而HR、MAP的差异无统计学意义(P>0.05)。结论改良俯卧位通气能有效改善老年腹部手术后并发ALI/ARDS患者的氧合状态,且对患者的HR、MAP无明显影响,是老年腹部手术后并发ALI/ARDS患者支持治疗的有效手段。实施过程中,要严密观察病情变化,做好各项护理工作。

Effects and Nursing for Modified Prone Position Ventilation in Aged Patients with Pulmonary Complications after Abdominal Surgery

Objective To explore the effect and nursing of modified prone position ventilation in the aged patients with acute lung injury （ALI）/acute respiratory distress syndrome （ARDS） after abdominal surgery. Methods From April 2010 to April 2011,modified prone position ventilation was used in 18 aged patients with ALI/ARDS after abdominal surgery. HR, MAP, SpO2, oxygenation index （Pao2/Fio2） were measured before ventilation and at 1 hour after modified prone position ventilation and at 2 hour after modified prone position ventilation to observe the effect on circulatory and oxygenation parameters. Results SpO2 ,Pao2/Fio2 were significantly higher at 1 hour after modified prone position ventilation and 2 hour after modified prone position ventilation than before ventilation（P〈0.01）, while no significant difference was found in HR and MAP（P〉0.05）. Conclusion Modified prone position ventilation improves oxygenation in the aged patients with ALI/ARDS after abdominal surgery. There were no significant effects on HR,MAP. Modified prone position ventilation is an effective method in the treatment of the aged patients with ALI/ARDS after abdominal surgery. During the implementation process, close observation should be conducted on the changes of disease with intensive nursing performance.