同期大容量肺泡灌洗治疗肺泡蛋白沉积症的围手术期护理

Perioperative nursing care of the large capacity for the same period lavage treatment of alveolar protein deposition disease

目的：探讨同期大容量肺泡灌洗治疗肺泡蛋白沉积症的术前术中和术后护理，提高治疗疗效。方法：回顾性分析无锡市人民医院近3年收治的5例肺泡蛋白沉积症患者的临床资料，重点分析同期大容量肺泡灌洗的围手术期的护理措施，观察患者肺泡灌洗前后血气改变。结果：3例患者灌洗术中血氧饱和度、心率、血压平稳，2例患者灌洗时出现短暂的血氧饱和度下降，经纯氧通气后回升。1例患者在回病室后1小时出现血氧饱和度迅速下降，呼吸加快，右肺出现干湿罗音，治疗后患者血氧饱和度逐渐上升并稳定于95％左右，呼吸平稳。5例肺泡蛋白沉积症患者在肺泡灌洗后临床症状均有明显好转，灌洗后血气分析提示低氧血症明显改善。结论：术前加强基础护理和营养支持，持续吸氧，术中密切观察生命体征及氧饱和度变化并防止静脉血栓形成，术后及时进行心理疏导，避免过度兴奋，增强抵抗力。

Objective： Explore the large--capacity in the same period lavage alveolar proteinosis preoperative and postoperative care, improve the therapeutic efficacy. Methods：Retrospective analysis of Wuxi City People＇s Hospital admitted in the past three years, five cases of pulmonary alveolar proteinosis in patients with clinical data, focusing on the analysis of large--capacity during the same period lavage, perioperatlve care measures observed blood gas change in patients before and after lavage. Result：The oxygen saturation, heart rate, blood pressure of three patients was stable during lavage ,two patients have short--term oxygen saturation decreased, rebound after oxygen ventilation during lavage. One patient backing to the ward have rapid decline in oxygen saturation, respiratory rate, lung wet and dry rales after one hour, oxygen saturation gradually rise and stabilize at around 95%, smooth breathing after treatment. The clinical symptoms of five patients with pulmonary alveolar proteinosis were markedly improved after lavage, blood gas analysis prompted hypoxemia significantly improve after lavage. Conclusion：Strengthening primary care and nutritional support before surgery, continuous oxygen, close observation of vital signs and oxygen saturation changes and surgery to prevent venous thrombosis, timely psychological counseling, avoiding over-- excitement, increasing endurance.