单肺正压通气控制支气管扩张大咯血的护理策略

Nursing Strategies During Mono-Pulmonary Positive Pressure Mechanical Ventilation for the Control of Bronchiectasic Hemoptysis

目的探讨单肺正压机械通气在支气管扩张大咯血救治中的作用及其护理策略。方法对26例符合支气管扩张大咯血诊断标准且不具备手术适应证的病例,在双腔管气管插管后实行单肺正压机械通气。在常规和Swan-Ganz导管监测下,设置不同的正性压力支持(PPS)和呼气末正压(PEEP),增加气道压力,观测咯血量和心肺功能并采取相应的临床护理措施。结果气道压力增加后咯血量明显减少,两者呈显著负相关(P<0.01)。PPS≤15cmH2O和PEEP≤7cmH2O时,心排血指数(CI)和射血分数(EF)随着气道压力升高而增加;而当PPS≥20cmH2O和PEEP≥9cmH2O时,上述指标随着气道压力的升高而下降。结论机械通气增加气道压有明显的止血作用,但需在气道压力、止血和心肺功能三者间维持动态平衡。

Objective To examine the effect of mono-pulmonary positive pressure mechanical ventilation on bronchiectasic hemoptysis and explore the nursing strategies. Methods Twenty-six patients with bronchiectasic hemoptysis who were not indicative of surgical treatment were subjected to positive pressure mechanical ventilation of single lung by intubation of double-lumen endotrachial tube. Under routine and Swan-Ganz catheter monitoring, the amount of hemoptysis and cardiopulmonary function in these patients were observed under different positive pressure support ventilation （PPS） and at positive end-expiratory pressure （PEEP） and nursing care was given accordingly. Results The amount of hemoptysis was decreased after airway pressure was increased and the two indices were negatively related （P〈0.01）. Ejection fraction （EF） and cardiac index （CI） increased with the increase of airway pressure when PPS≤15 cmH2O and PEEP≤ 7cmH2O, but EF and CI decreased with the increase of airway pressure when PPS≥ 20 cmH2O and PEEP≥9 cmH2O. Conclusion Increasing airway pressure has good effects on hemostasis during the mechanical ventilation. It is of great importance to maintain a dynamic balance among airway pressure, hemostasis and cardiopulmonary function.