BiPAP呼吸机治疗呼吸衰竭发生腹胀的影响因素分析及护理

Influential factors and nursing points of the abdominal inflation in the treatment of respiratory failure using BiPAP facial mask ventilation

目的探讨双水平气道内正压(bi-level positive airway pressure,BiPAP)鼻面罩呼吸机治疗呼吸衰竭过程中发生腹胀的影响因素和护理要点,为临床护理提供依据。方法回顾性分析2008年2-9月60例用BiPAP鼻面罩呼吸机治疗呼吸衰竭的急诊重症监护病房(emergency intensive care unit,EICU)住院患者的临床资料,分析影响腹胀的因素。结果 60例中共有22例患者发生腹胀,腹胀发生率为36.6%;24 h无创通气总时间、张口呼吸是腹胀发生的危险因素(P<0.05);自主进食是腹胀发生的保护因素(P<0.05),鼻饲及胃肠减压、吸入正压支持与呼出正压支持的设定对腹胀影响,差异无统计学意义(均P>0.05)。结论 24 h无创通气总时间越长越容易导致腹胀,因此使用BiPAP呼吸机治疗必须定时脱机休息;张口呼吸是腹胀发生的高危因素;针对性的护理是避免或减轻腹胀的关键措施。

Objective To investigate the influential factors and nursing strategies of abdominal inflation in the treatment of respiratory failure using BiPAP facial mask ventilation.Methods Data of 60 hospitalized patients from February 2008 to September 2008 under BiPAP facial mask ventilation treatment were chosen from the EICU.The influential factors including IPAP,EPAP,total time of non-invasive ventilation during 24h,opening mouth breath,nasal feeding,gastrointestinal decompression,dieting were collected during 24 h observation and the clinical evidences that cause abdominal inflation analyzed.Results 22 cases contracted abdominal inflation with an incidence rate of 36.6%.The total time non-invasive ventilation during 24 h and opening mouth breath were risk factors（P 0.05）.Self-dieting was the protective factor（P 0.05）.Nasal feeding,gastrointestinal decompression,IPAP,EPAP had no remarkable effects on abdominal inflation（P 0.05）.Conclusion The longer the total time non-invasive ventilation during 24 h is,the higher the risk for contracting abdominal inflation.In order to avoid the abdominal inflation,it is crucial to have a rest by taking off mask during the BiPAP noninvasive ventilation procedure.The opening mouth breath is high risk factor.Corresponding nursing care is key to avoidance or relief of abdominal inflation.