重度脊柱侧弯患者围术期呼吸道护理

Perioperative respiratory care in severe scoliosis patients

目的探讨重度脊柱侧弯患者围手术期呼吸道护理要点。方法对26例重度脊柱侧弯患者实施矫形手术,术前指导患者进行呼吸功能训练,术后给予呼吸道管理,保持呼吸道通畅,有效疼痛管理及加强呼吸道并发症观察和护理。结果呼吸训练前后患者用力肺活量(forced vital capacity,FVC)平均为45.9%与52.1%,第1 s用力呼气容积(forced expiratory volum in one second,FEV1)平均为43.8%与48.8%;肺功能有改善患者18例,占69.2%;术后10 d内2例患者发生血、气胸,3例患者发生轻、中度胸腔积液,经有效治疗和护理均能安全渡过围手术期。结论围手术期系统、有效的呼吸功能训练以及呼吸道管理能改善患者肺功能,提高手术安全性及减少术后肺部并发症的发生,促进患者早期康复。

Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients. Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected. All of them tested pulmonary function before and after training, postoperative respiratory system nursing were also taken to maintain airway unobstructed, including respiratory rate and oxygen saturation monitoring, effective pain management and respiratory complications controlling. Results The average forced vital capacity （FVC） was 45.9% and 52.1% before and after breathing exercises, the mean forced expiratory volume in one second （FEV1） was 43.8% and 48.8% before and after breathing exercises, with lung function improvement in 69.2% patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery, but all recovered after effective treatment and nursing. Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety, reduce the incidence of postoperative pulmonary complications, and promote early rehabilitation.