Stanford A型主动脉夹层肥胖患者术后低氧血症的护理  

Nursing care of postoperative hypoxaemia in obese patients with Stanford type A aortic dissection

作　　者：郭晨 宋亚敏[1] Guo Chen;Song Yamin(Cardiovascular Surgery Intensive Care Unit,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,南方医科大学附属广东省人民医院(广东省医学科学院)心外科重症监护室,广东广州510080

出　　处：《护理学杂志》2023年第21期46-49,共4页Journal of Nursing Science

基　　金：广东省医学科研基金项目(A2022433)。

摘　　要：目的总结Stanford A型主动脉夹层肥胖患者术后低氧血症的护理经验,为临床护理提供参考。方法对41例Stanford A型主动脉夹层行心脏大血管手术后发生低氧血症的肥胖患者,实施肺保护通气策略及俯卧位通气,密切观察病情,预防谵妄发生,实施低氧血症早期康复护理。结果41例患者低氧血症全部改善,36例患者成功转出心外重症监护室且康复出院,5例患者因肢体肌力未完全康复转其他医院继续康复治疗。住院时间5~52(20.7±8.6)d,ICU时间40~851 h(中位时间247 h),机械通气辅助时间16~710 h(中位时间181 h)。结论Stanford A型主动脉夹层肥胖患者低氧血症发生率高,术后严密监测病情变化,尽早采取针对性干预措施,对纠正患者低氧血症,尽快脱离呼吸机,改善临床预后具有重要意义。Objective To summarize the nursing experience of postoperative hypoxaemia in obese patients with Stanford type A aortic dissection,so as to provide a reference for clinical nursing.Methods A total of 41 obese patients with Stanford type A aortic dissection who suffered from hypoxaemia after cardiac surgery were selected,their nursing interventions included lung protective ventilation strategy and prone position ventilation,closely condition observation,delirium prevention strategy,and early rehabilitation nursing for hypoxaemia.Results Hypoxaemia improved in all the 41 patients,36 of them were successfully transferred out of the cardiac intensive care unit and discharged,and the other 5 patients were transferred to other hospitals to continue rehabilitation treatment because of incomplete recovery of limb muscle strength.Their length of hospitalization was 5-52(20.7±8.6)days,and their stay in ICU was 40 to 851 hours,the median of which was 247 hours,and the time of mechanical ventilation assistances was 16-710 hours,and its median was 181 hours.Conclusion The incidence of postoperative hypoxaemia in obese patients with Stanford type A aortic dissection is high,and it is significant to monitor the patients′condition change closely after surgery,and take targeted interventions as early as possible,so as to correct their hypoxaemia,get off the ventilator as soon as possible,and improve their clinical prognosis.

关 键 词：Stanford A型 主动脉夹层 肥胖 低氧血症 机械通气 俯卧位通气 谵妄 康复护理 

分 类 号：R473.5[医药卫生—护理学]