无创呼吸机治疗慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者的临床护理

Clincal nursing for chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure by the treatment of noninvasive ventilator

目的 观察并探讨对应用无创呼吸机治疗的慢性阻塞性肺疾病（COPD）伴Ⅱ型呼吸衰竭患者实施临床护理的有效方法.方法 选择衢州市人民医院2010年2月～2013年4月收治的COPD伴Ⅱ型呼吸衰竭患者64例,随机将其分为实验组（32例）和对照组（32例）,在常规治疗的基础上给予对照组机械通气治疗的一般护理,实验组在对照组治疗的基础上给予精心的整体性护理.监测两组患者治疗前后心率、呼吸频率和动脉血气的变化;观察并记录两组患者的住院时间及治疗护理前后临床症状的改变;通过比较上述指标的变化来评价两种护理方法对患者的影响.结果 治疗后实验组患者心率、呼吸频率、动脉血气及临床症状的改善明显优于对照组;实验组12例嗜睡的患者中,治疗后神志清醒10例,神志好转1例,昏迷1例,患者平均住院时间为（15.6±3.8）d;对照组13例嗜睡的患者中,治疗后神志清醒7例,神志好转3例,昏迷3例,平均住院时间为（19.5±6.8）d,实验组住院时间明显少于照组,两组间各指标相比,差异均有统计学意义（均P＜ 0.05）.结论 整体护理能显著改善无创呼吸机治疗COPD伴Ⅱ型呼吸衰竭患者的临床症状、体征,并缩短住院时间,减轻患者的经济和身体负担,临床疗效显著,值得在临床上进一步推广.

Objective To observe and study the effective methods of clinical care for patients with chronic obstructive pulmonary disease （COPD） with type Ⅱ respiratory failure by the treatment of noninvasive ventilator.Methods 64 COPD patients with type Ⅱ respiratory failure were treated by noninvasive ventilator from February 2010 to April 2013 in the People＇s Hospital of Quzhou City were randomly divided into the experiment group （32 cases） and control group （32 cases）.Based on the general treatments,the control group was given the common nursing of mechanical ventilation treatment,and the experiment group was given the holistic nursing in addition.The changes of heart rate,respiratory rate and arterial blood gas of two groups before and after treatment were monitored; the hospital stays and changes of clinical symptom before and after nursing were observed and recored; the effects of the two nursing ways for the patients were evaluated according to all above indexes of the two groups.Results The improvement of heart rate,respiratory rate and arterial blood gas of experiment group after treatment was much better than those in control group.There were 10 consciousness patients,1 patient with improved mind and 1 comatose patient after treatment among 12 sleepiness patients of experiment group,and the mean hospital stay was （15.6±3.8） d; there were 7 consciousness patients,4 patients with improved mind and 3 comatose patients after treatment among 13 sleepiness patients of control group,the mean hospital stay was （19.5±6.8） d.the hospital stay of experiment group was less than that in control group,the indexes between the two groups had statistically significant differences （all P 〈 0.05）.Conclusion The holistic nursing can significantly improve clinical symptoms and signs of COPD patients with type Ⅱ respiratory failure by the treatment of noninvasive ventilator,shorten the hospital stays,reduce the patient＇s burden of economy and body,and has significant effect,which is worthy of clinical application.