上颈段颈椎不稳手术患者呼吸功能评估及护理

Assessment of Respiration of Patients with Upper Cervical Vertebrae Instability and Nursing Care

总结60例上颈段颈椎不稳手术患者的呼吸功能评估及护理体会。术前和术后予支配呼吸肌的神经系统评估和呼吸功能评估,患者的呼吸功能损害多由于呼吸肌瘫痪引起,一般不会出现“三凹征,”值得注意。术前、术后予上颈段颈椎制动,本组行颈围固定16例,枕颌带牵引34例,颅骨牵引10例;加强有效的呼吸、排痰训练和呼吸功能锻炼;术后保持呼吸道通畅,预防呼吸道感染;密切观察术后切口情况,预防伤口渗液、渗血压迫气道和脊髓神经。经手术治疗和精心护理,本组不完全性四肢瘫痪的31例患者均有不同程度恢复;完全性四肢瘫痪的17例患者7例部分得到恢复,10例麻木、疼痛缓解,四肢瘫痪无变化。

The paper summarized the assessment of respiration of 60 patients with upper cervical vertebrae instability and nursing experience. Before and after operation, nerve system supporting respiratory muscle and respiratory function were assessed. The damage of respiratory function was mostly caused by paralysis of respiratory muscle, which should be paid attention. In the group, patients enhanced effective respiration and discharging sputum as well as respiratory function training before and after operation. After operation, respiratory tract was keep unblocked, infection was prevented, incision was carefully observed and pressing on nerve system by hemorrhage was prevented. After operation and careful nursing, 31 patients recovered to different extents. 7 of 17 patients with quadriplegia recovered partly. 10 alleviated pain but still had quadriplegia.