32例危重症甲型H1N1流感患者的临床观察及护理

Clinical observation and nursing care of 32 cases with severe influenza A （ H1 N1 ） infection

目的总结危重症甲型H1N1患者的治疗方法及护理措施。方法对32例H1N1患者均机械通气治疗，选择压力通气模式，即同步间歇指令通气压力模式（SIMV＋PSV＋PEEP），PEEP及FiO2的设定根据患者的氧合水平进行滴定式设定。控制潮气量（6—8ml／kg），PEEP不超过20cmH2O，限制平台压不超过35cmH2O，每小时记录心率、血压、脉搏、血氧饱和度，左、右侧俯卧位通气每2h交替一次，每次吸痰后及时给予肺复张（LR），每天进行动脉血气分析、血常规、c-反应蛋白，凝血指标，肝功、肾功、心肌酶监测、胸部x线检查。结果32例中26例动脉血气指标得到改善，PaO2〉80mmHg，病情好转，并逐步脱机，6例死于顽固性低氧血症。结论甲型H1N1患者在治疗过程中尽早给予奥斯他韦治疗，实施肺保护通气策略，密切观察生命体征，及时监测化验项目，加用俯卧位通气，加强气道管理、减少吸痰次数是护理的关键。

Objective To summarize the treatment and nursing care of critically ill patients with A （ H1 N1 ） influenza infection. Methods 32 cases with severe influenza A （ H1 N1 ） infection were ventilated with synchronized intermittent mandatory ventilation pressure mode （ SIMV ＋ PSV ＋ PEEP）, PEEP and FiO2 were ti- trated to get the optimal oxygenation and tidal volume was controled within 6-8 ml/kg, PEEP ≤20 cm H2 O, plateau pressure≤35 cm H20. Heart rate,blood pressure,oxygen saturation were recorded every two hours; Right- and left lying position were alternately conducted every 2 hours; lung recruitment （LR） was performed every when sputum suction was done; arterial blood gas analysis, C-reactive protein, coagulation parameters, liver function, renal function, myocardial enzyme test were checked daily and also chest X-ray examination. Results Of 32 patients ,26 improved in oxygenation index, and were weaned off successfully,6 patients died of refractory hypoxemia. Conclusion Severe influenza A （H1N1） infection patients should be treated with osehamivir as soon as possible. The implementation of lung protective ventilation strategy, close observation of vital signs, timely monitoring of laboratory tests, taking prone position ventilation reducing the frequency of sputum suction are most important.