11例光疗新生儿急性呼吸危象发作原因及护理

Causes and Nursing of Acute Respiratory Crisis among Newborns Undergoing Phototherapy: A Case Report

分析11例光疗新生儿急性呼吸危象发作的原因与眼罩固定不当,箱内物理环境改变,新生儿光疗中多哭闹、易呕吐,致血清游离钙降低等有关。护理中加强对光疗新生儿生命体征与呼吸形态的监测,固定眼罩时慎用高弹力绷带绕头围加压包扎,建议采用一次性口罩的带子固定;改善箱内干燥灼热的空气环境;喂奶后拍背排气,避免患儿哭闹和呕吐,提供舒适的治疗环境。本组发生急性呼吸危象的患儿经积极治疗和护理,10例患儿危象发作症状在10 min内相继消失,1例患儿经负压吸引清理口鼻腔分泌物,症状未能缓解,予雾化吸入后30 min气喘、憋气症状解除。6例患儿由于经皮测胆红素恢复正常提前终止光疗,其余患儿继续光疗至结束未再出现急性呼吸危象。

Causes of acute respiratory crisis among 11 newborns undergoing phototherapy were correlated to unstable eyeshield, altered physical environment in box, and decreased free serum calcium due to tendency of frequent cries and vomit in phototherapy. We suggested enhancing the monitoring of vital signs and respiration among newborns undergoing phototherapy and adopting tape of disposable masks for eyepatch stabilization rather than circling the head with pressure by elastic bandage. A comfortable therapeutic condition can be provided to newborns by improving the dry, glowing aerial environment. The cries and vomit can be avoided by gas emission through flapping baby＇s back. After the active treatment and nursing, crises disappeared in 10 newborns 10 minutes after the onset but did not improve in 1 baby who received negative pressure suction and then aerosol inhalation. Six newborns withdrew phototherapy in advance and the rest were void of crises after resuming phototherapy.