阻塞性睡眠呼吸暂停低通气综合征初次接受无创呼吸机治疗26例的观察与护理

OBSERVATION AND NURSING INTERVENTION OF THREE NIGHTS WITH NASAL CPAP TREATMENT IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME

目的通过对26例确诊阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,连续3d进行无创呼吸机治疗并进行睡眠日记调查,分析无创呼吸机治疗中出现不适症状的原因,制定护理对策,提高无创呼吸机治疗的依从性。方法对接受无创呼吸机治疗的患者连续3d进行晨起睡眠日记调查,记录治疗中出现的不适症状、夜间醒来的次数和反复启动呼吸机的次数;对采集到的文字数据进行统计描述,对3d的夜间醒来的次数和呼吸机反复启动次数进行方差检验分析。结果 26例中23例(88.46%)患者接受了连续3d的无创呼吸机治疗,并依时日对每天治疗后起床时的精神恢复、精神部分恢复和疲劳的状态描述率依次为6/23-13/23-4/23、5/23-16/23-2/23和11/23-12/23-0/23;此23例患者中,有面部受压者84.62%、皮肤过敏者19.23%、口鼻干燥但醒后很快消失者53.85%、口鼻干燥且醒后一直存在者42.31%、鼻塞但醒后很快消失者53.85%、鼻塞且白天一直存在者34.62%、耳鸣者26.92%、腹胀者23.08%;同时有11/26(占42.31%)的患者配置了无创呼吸机。结论关注OSAHS患者呼吸机治疗初期不适症状的护理,有助于提高其接受无创呼吸机的依从性。

Objective To investigate the CPAP compliance over the initial 3 days of treatment in a group of 26 patients with moderate to severe OSAHS and adverse reactions were recorded . The countermeasures of the nursing intervention were lay down in order to improve the CPAP compliance. Methods The patients were evaluated by way of a sleep diary the next morning for the continuous 3 - days CPAP treatment. The adverse reactions, the awaked frequency and the times of the turning on the CPAP were observed and recorded. The data were gathered and in statistics description. Results 23 patients were accomplished with continuous 3 - days CPAP treatment. The ratio of the fully recovery, partly recovery and fatigue for the continuous 3 - days were 6/23 - 13/23 - 4/23, 5/23 - 16/23 - 2/23 and 11/23 - 12/23 - 0/23 respectively. In which the adverse reactions were the stress coming from the mask （84.62 %）, skin hypersensitivity （19. 23%）, dry mouth or nose disappeared after awaked （53.85%）, dry mouth or nose last after awaked （42. 31%）, nasal obstruction disappeared after awaked（53.85%）, nasal obstruction for the next whole day after awaked（34.62%）, tinnitus（26.92%）and abdominal distension（23.08%）. Conclusion It would pay more attention on the nursing intervention during the CPAP treatment initially for the OSAHS patients, which can improve the CPAP compliance.