慢阻肺呼吸衰竭患者双水平无创正压机械通气中护理模式的探讨

The investigation of care model about using bi-level positive airway pressure ventilation to treat chronic obstructive pulmonary disease compicated with respiratory failure

目的:通过对慢性阻塞性肺疾病合并呼吸衰竭患者实施双水平无创正压机械通气效果与护理方法的相关性研究,探讨较完善的护理模式。方法:对97例慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭的住院患者,应用双水平无创正压呼吸机(BIPAP)呼吸机辅助通气,操作前进行患者及家属的相关教育、清理呼吸道、做好心理疏导及鼓励患者坚持72小时戴机等措施;并进行治疗前后生理、临床指标比较,进行多因素回归分析。结果:戴机成功与操作前患者及家属的教育、充分的呼吸道清理、心理护理及专护、持续戴机时间有统计学意义,而呼吸机模式、氧浓度与戴机成功无统计学意义。结论:建立有效的护患沟通;保障气道通畅;心理安慰;戴机后专护;保证戴机初期(72 h内)通气时间的护理模式,是提高患者无创通气的依从性及保证疗效的重要因素。

Objective：To investigate the care model of using bi-level positive airway pressure ventilation to treat acute and chronic respiratory failure. Methods：97 inpatients with chronic obstructive pulmonary disease and respiratory failure were adopted. Bi—level positive airway pressure （BIPAP）mechanical assisted ventilation were applied to them. Correlation coefficients and multivariable regression models were used to determine the association between whether the patients were given pneogaster cleaing, psychological care,halfhour accompany,seventy two hours maintenance of BIPAP, and the physilological and clinical index before and ofter treatment were compared. Results： Health related education, well pneogaster given, psychological care, halfhour accompany were correlated with the success of BIPAP. However, the breathe model, and the oxygen concentration were not associated with it. Conclusions：Well communication with the patients and their family members, psychological care, halfhour accompany, cleaning pneogaster and maintenance of BIPAP as long as possible in the first seventy two hours are significant factors that affects the compliance and curative effect of BIPAP.