戴园园，黄丽丽，张卫红，余 嫣

(台州市第一人民医院，浙江 黄岩 318020)

·临床护理·

1例重度胸廓畸形合并肺心病行序贯通气治疗的护理

戴园园，黄丽丽@，张卫红，余 嫣

(台州市第一人民医院，浙江 黄岩 318020)

总结1例严重胸廓畸形伴肺心病、Ⅱ型呼吸衰竭行序贯通气治疗的护理。本例患者先天脊柱侧凸、重度胸廓畸形、不能平卧，给治疗和护理带来一定的困难。此患者在进入我科时行经口气管插管、呼吸及辅助呼吸，进科第3天实施了序贯通气治疗。因该患者有肺水肿、肺动脉高压的存在，在序贯通气治疗期间通气模式反复改变调整以适应患者病情需要。围绕着如何做好患者序贯通气的护理、液体控制管理、心理护理等展开救护。经过积极有效的护理，7天后患者病情稳定转入普通病房，12天后顺利出院。

胸廓畸形；序贯通气；肺心病；护理

Abstract: To sum up 1 case nursing care of severe thoracic deformity with pulmonary heart disease and type II respiratory failure with sequential ventilation. It is difficult treatand nursepatients with congenital scoliosis, severe chest deformity and not supine. The patientwas treated with epidemic orotracheal intubation, breathing and assisted respiration and three days’ implementation of sequential mechanical ventilation.Because of pulmonary edema and pulmonary hypertension, the ventilation mode was changed to adapt to the needs of the patients during the sequential ventilation. This article is focused on how to nurse patients with sequential ventilation, liquid control management, psychological care, and so on.After active and effective care, the patient's condition was stable to transfer the general ward after 7 days and released from hospital after 12 days.

Keywords: thoracic deformity; sequential ventilation; pulmonary heart disease; nursing

脊柱侧凸和胸廓畸形不仅影响患者外观，更重要的是影响肺脏的正常生长发育，导致不可逆的肺功能损害，严重病例甚至出现呼吸衰竭，生存期缩短[1]。序贯机械通气治疗是指：经人工气道机械通气(Endotracheal Mechanical Ventilation，ETMV)的患者，在未满足拔管和撤机的条件下，提前拔管，改用无创正压机械通气(Non-Invasive Positive Pressure Ventilation，NIPPV)，然后逐渐撤机的通气方式[2]。序贯机械通气对改善呼吸肌疲劳和通气功能有一定意义，使呼吸机相关性肺炎发生机会明显减少，并缩短ICU住院时间[2]。我院在2015年5月收治1名先天脊柱侧凸、重度胸廓畸形合并肺心病、肺水肿，行序贯通气治疗的患者，经治疗和护理，患者转危为安，顺利出院，现将护理体会报告如下。……