无创正压通气在人感染H7N9重症患者中的应用和护理  

Application and Nursing of the Noninvasive Positive Pressure Ventilation on Patients With Severe H7N9 Avian Influenza

作　　者：许璐[1] 陈丽花[1] 钟爱勤 胡清莲[1] 黄小群[1] 侯春怡[1] 

机构地区：[1]广州医科大学附属第一医院重症医学科,广东省广州市150120

出　　处：《中国全科医学》2015年第33期4064-4067,共4页Chinese General Practice

摘　　要：目的探讨无创正压通气(NIPPV)在人感染H7N9禽流感重症患者中的应用和护理。方法选取2013年8月—2014年3月广州医科大学附属第一医院救治的8例人感染H7N9禽流感重症患者,其中4例一直使用NIPPV治疗,4例使用NIPPV序贯治疗,给予患者、护士心理护理,无创呼吸机应用的护理和并发症的观察和预防,消毒隔离等措施,观察患者治疗前后呼吸频率(RR)、心率(HR)、pH、氧分压(Pa O2)、二氧化碳分压(Pa CO2)、血氧饱和度(Sp O2)、氧指数(OI)。结果 4例一直使用NIPPV治疗患者呼吸窘迫改善,4例拔除气管插管患者使用NIPPV后,无呼吸窘迫症状;3次咽拭子送疾病控制中心(CDC)检测后H7N9病毒核酸均为阴性,予以解除隔离,患者均康复出院。使用NIPPV治疗前后,患者pH、Pa CO2比较,差异均无统计学意义(P>0.05);使用NIPPV治疗后,患者RR、HR、Pa O2均低于治疗前,Sp O2、OI均高于治疗前,差异有统计学意义(P<0.05)。结论 NIPPV能够减少呼吸肌做功,降低患者的耗氧量,是治疗呼吸系统疾病的重要方法。人感染H7N9重症禽流感的传播途径主要是接触或呼吸道,做好护士和患者的心理护理、指导患者正确配合使用无创呼吸机,及时启动消毒隔离应急预案是成功救治患者的关键。Objective To investigate the application and nursing of noninvasive positive pressure ventilation（ NIPPV）on patients with severe H7N9 avian influenza. Methods From August 2013 to March 2014,we enrolled 8 patients with severe H7N9 avian influenza who received treatment in the First Affiliated Hospital of Guangzhou Medical University. Of the 8 subjects,4 subjects were administrated with NIPPV during the whole treatment and 4 subjects were administrated with NIPPV sequential therapy. A series of measures were taken,including psychological nursing given to the subjects and nurses,nursing during the application of NIPPV,observation and prevention of complications,disinfection,isolation,etc. We recorded RR,HR,pH,Pa O2,Pa CO2,Sp O2 and OI of the subjects before and after treatment. Results The 4 subjects who were administrated with NIPPV during the whole treatment had alleviation in respiratory distress,and the 4 subjects who applied NIPPV after removing trachea cannula didn＇t have respiratory stress; three times of CDC test on throat swab showed H7N9 viral nucleic acid negative,after which quarantine was cancelled and all subjects were all discharged from hospital upon recovery. The pH and Pa CO2 of the subjects after NIPPV treatment were not significantly different from those before treatment（ P〉0. 05）; after NIPPV treatment,the RR,HR and Pa O2 of the subjects were lower than those before treatment,and Sp O2 and OI were higher than those before treatment（ P〈0. 05）. Conclusion NIPPV can reduce the work of respiratory muscle and reduce the oxygen consumption of patients. It is an important method in the treatment of respiratory diseases. H7N9 severe avian influenza spreads mainly through contact or respiratory infection. Psychological nursing on nurses and patients,guidance on patients with the used of noninvasive ventilator and timely launch of emergency plans, such as disinfection and isolation are the key elements for the successful treatment of severe H7N9 avian influenza.

关 键 词：禽流感 H7N9 无创正压通气 护理 

分 类 号：R512.99[医药卫生—内科学]