红喘型与紫肿型慢性阻塞性肺病患者夜间低氧血症原因分析及护理对策

目的探讨红喘型与紫肿型慢性阻塞性肺病（chronic obstructive pulmonary disease,COPD）患者夜间低氧血症原因及总结护理对策。方法对本科室收治的22例COPD患者（包括红喘型、紫肿型）采用经皮血氧饱和度（pulse oxygen saturation,SPO2）监测其夜间血氧饱和度（arterial oxygen saturation,SaO2）情况。结果两型COPD患者最低血氧饱和度（LSPO2）,平均血氧饱和度（MSPO2）、日夜间SPO2差值比较,差异具有统计学意义（均P〈0.01）,红喘型患者夜间低氧程度相对较轻,低氧血症出现的时间较晚,持续的时间较短,紫肿型患者夜间低氧程度较重,低氧血症出现的时间较早,持续的时间较长。结论红喘型与紫肿型COPD患者夜间低氧的原因可能与睡眠状态下通气量的病理性下降、通气—血流比例失调、睡眠中呼吸驱动作用减弱及呼吸肌疲劳有关,应采取针对性的护理对策,尤其是紫肿型COPD患者使患者夜间SPO2下降幅度降低,减轻肺动脉高压的发生,降低呼吸衰竭及猝死的发生率。

Analysis of causes of nighttime hypoxemia in 22 COPD patients

Objective To explore the causes of nighttime hypoxemia in COPD(chronic obstructive pulmonary disease)patients and sum up the nursing strategies.Method The monitoring was done over the nighttime SaO2 of 22 COPD patients(pink puffer and blue bloater).Results There were significant differences between the two types of COPD at LSaO2,MSaO2 and SaO2(P<0.01 for all).For those with pink puffer COPD,the nighttime hypoxemia was milder in symptoms and shorter in time,compared to those with blue bloater COPD.Conclusions The nighttime hypoxemia may be caused by lowering of air flow at sleep,disturbed proportion of air flow and blood flow,weakening of respiratory dynamics and muscular fatigue.Pertinent nursing strategy can be applied to lower the nighttime SPO2,suppress the incidence of pulmonary hypertension and ultimately decrease the respiratory failure and sudden death.