急危重症患者异常呼吸波形特点分析

Characteristics of Respiratory Waves of Critical Patients with Abnormal Respiration

目的分析急危重症患者异常呼吸波形特点,为急危重症早期护理提供快捷的依据。方法选择急救过程中使用呼吸波形监测患者100例,在不影响临床护理前提下,总结无自主呼吸、限制性通气障碍、阻塞性通气障碍、呼吸道分泌物(痰液)蓄积和异常呼吸运动5种症状各20例患者在急救护理过程中出现带有典型特征异常呼吸波形时的呼吸波形特点;分析比较不同部位呼吸道分泌物蓄积时所出现的异常呼吸波形特点及分泌物被清除前后压力变化。结果 (1)无自主呼吸、限制性通气障碍、阻塞性通气障碍、呼吸道分泌物(痰液)蓄积和异常呼吸运动5种症状的患者,在呼吸波形上可形成带有典型特征的异常呼吸波形图象如:"海棠叶"状、"柳树叶"状或"钝角三角形"状、"鸭嘴"状或"鸟嘴"状、"火炬"状或"锯齿"状或"波纹"状、"8"字形扭曲状等与正常波形相比有显著改变的呼吸波形。(2)当呼吸道分泌物蓄积时,可出现"火炬状""锯齿状""波纹状"等异常呼吸波形。当蓄积的呼吸道分泌物清除(吸痰)后,这些异常呼吸波形可发生演变或消失。在清除呼吸道分泌物(吸痰)前后,压力—容量环的低拐点和高拐点处的气道压力变化显著,吸痰后气道压力明显低于吸痰前(P<0.01)。结论特定的急危重症在呼吸波形上可形成带有典型特征的异常呼吸波形图象。当监测到"海棠叶"状、"柳树叶"状或"钝角三角形"状、"鸭嘴"状或"鸟嘴"状、"火炬"状或"锯齿"状或"波纹"状、"8"字形扭曲状等带有形象特征的异常呼吸波形图象时,提示有相应的急危重症变化,有助于急危重症的早期、直观、快速诊断和急救护理,对提高危重症护理质量有重要的临床指导意义。

Objective To analyze the characteristics of respiratory waves of critical patients with abnormal respiration and to provide reference for nursing of critical patients in early stage.Methods 100 patients with respiratory wave monitoring were included in the study.Characteristics of respiratory waves were recorded for patients with abnormal respirations such as non-spontaneous respiration,restrictive ventilation disorder,obstructive ventilation disorder,accumulation of respiratory secretion,abnormal respiration during their emergency nursing.Abnormal characteristics of respiration wave along with secretion accumulation were analyzed and pressure changes before and after the clearing of secretion were compared.Results There were some typical images appearing in respiratory wave which were different from normal images such as crabapple leaf,willow leaf or obtuse triangle or duckbilled-shaped image,beak-shaped image,torch,saw tooth,ripple,and 8-shaped wave.When there was secretion accumulation,images such as torch,saw tooth,ripple appeared,which would disappeared or changed as well with the clearing of secretion.Airway pressure was obviously lower in the low and high inflection point of pressure volume loop after the elimination of secretion（P0.01）.Conclusion Some typical images in respiratory waves of special critical illness indicate the development of the disease,which benefits and improves emergency nursing care.