胸部肿瘤切除术后低氧血症的原因分析及护理

目的 分析胸部肿瘤切除术后低氧血症的原因，探讨相应的护理对策。方法 将536例进行胸部肿瘤切除的病人按术式分成食管癌根治术组、单肺叶切除组、双肺叶和全肺切除组，分别于术前、术后的第1、2、3、7天进行血气分析，比较各组病人各天的血氧分压情况，分析其术式与术后并发症的发生率情况。结果 三组病人术前的肺通气功能和动脉血氧分压无明显差异，但术后均有不同程度的低氧血症，尤以术后第2天表现明显。术后并发症最常见的为心律失常和呼吸困难，其中食管癌根治术组并发症发生率明显高于单肺叶切除组。结论 胸部肿瘤切除术后低氧血症的发生是不可避免的，其发生原因与术式、手术时间及术后病人不能及时清理道分泌物等因素有关，提出加强围手术期病人的健康教育，指导和协助病人进行正确有效的咳嗽排痰，结合合理的氧疗，有效的镇痛等护理对策，可有效防止低氧血症的发展，防止其他并发症的发生。

Analysis and nursing of hypoxemia after thoracic tumor resection

ObjectiveTo analyze the causes of postoperation hypoxemia in thoracic tumor resection, and probe into suitable nursing care.Methods536 patients who had a thoracic tumor operation were divided into esophagectomy group, single lobectomy group and double lobectomy and pheuonectomy group according to the operation mode. The blood gas analysis (BGS) was conducted before operation and at d 1,2, 3 and 7 after operation between each group and each day. The PaO 2 between each group and each day were compared and the relations were analyzed between the operation and the postoperative complications.ResultsThere was no significant difference in preoperative PaO 2 between three groups, but difference degree postoperative hypoxemia occurred, especially obvious in second day after operation. The most common complications were arrhythmia and dyspnea and the incidence was much higher in the esophagectomy group than that in the single lobectomy group.ConclusionThe postoperative hypoxemia of thoracic tumor resection is inevitable. The causes are related to many factors including operation mode, operation time and the patients unable to expectorate respiratory secretion. It shows that strengthening the health education for perioperative patients, instructing and helping them to proceed right and effective cough and eject sputum, combining proper oxygen inhalation and effective analgesic, can prevent the progress to hypoxemia effectively, further to prevent occurrence of other complications.