CAJ | 학술논문

目的：探讨无创正压通气（NIPPV）在人感染 H7N9禽流感重症患者中的应用和护理。方法选取2013年8月—2014年3月广州医科大学附属第一医院救治的8例人感染 H7N9禽流感重症患者，其中4例一直使用NIPPV 治疗，4例使用 NIPPV 序贯治疗，给予患者、护士心理护理，无创呼吸机应用的护理和并发症的观察和预防，消毒隔离等措施，观察患者治疗前后呼吸频率（RR）、心率（HR）、pH、氧分压（PaO2）、二氧化碳分压（PaCO2）、血氧饱和度（SpO2）、氧指数（OI）。结果4例一直使用 NIPPV 治疗患者呼吸窘迫改善，4例拔除气管插管患者使用NIPPV 后，无呼吸窘迫症状；3次咽拭子送疾病控制中心（CDC）检测后 H7N9病毒核酸均为阴性，予以解除隔离，患者均康复出院。使用 NIPPV 治疗前后，患者 pH、PaCO2比较，差异均无统计学意义（P ＞0.05）；使用 NIPPV 治疗后，患者 RR、HR、PaO2均低于治疗前，SpO2、OI 均高于治疗前，差异有统计学意义（P ＜0.05）。结论 NIPPV 能够减少呼吸肌做功，降低患者的耗氧量，是治疗呼吸系统疾病的重要方法。人感染 H7N9重症禽流感的传播途径主要是接触或呼吸道，做好护士和患者的心理护理、指导患者正确配合使用无创呼吸机，及时启动消毒隔离应急预案是成功救治患者的关键。
목적：탐토무창정압통기（NIPPV）재인감염 H7N9금류감중증환자중적응용화호리。방법선취2013년8월—2014년3월엄주의과대학부속제일의원구치적8례인감염 H7N9금류감중증환자，기중4례일직사용NIPPV 치료，4례사용 NIPPV 서관치료，급여환자、호사심리호리，무창호흡궤응용적호리화병발증적관찰화예방，소독격리등조시，관찰환자치료전후호흡빈솔（RR）、심솔（HR）、pH、양분압（PaO2）、이양화탄분압（PaCO2）、혈양포화도（SpO2）、양지수（OI）。결과4례일직사용 NIPPV 치료환자호흡군박개선，4례발제기관삽관환자사용NIPPV 후，무호흡군박증상；3차인식자송질병공제중심（CDC）검측후 H7N9병독핵산균위음성，여이해제격리，환자균강복출원。사용 NIPPV 치료전후，환자 pH、PaCO2비교，차이균무통계학의의（P ＞0.05）；사용 NIPPV 치료후，환자 RR、HR、PaO2균저우치료전，SpO2、OI 균고우치료전，차이유통계학의의（P ＜0.05）。결론 NIPPV 능구감소호흡기주공，강저환자적모양량，시치료호흡계통질병적중요방법。인감염 H7N9중증금류감적전파도경주요시접촉혹호흡도，주호호사화환자적심리호리、지도환자정학배합사용무창호흡궤，급시계동소독격리응급예안시성공구치환자적관건。
Objective To investigate the application and nursing of noninvasive positive pressure ventilation(NIPPV) on patients with severe H7N9 avian influenza. Methods From August 2013 to March 2014,we enrolled 8 patients with severe H7N9 avian influenza who received treatment in the First Affiliated Hospital of Guangzhou Medical University. Of the 8 subjects, 4 subjects were administrated with NIPPV during the whole treatment and 4 subjects were administrated with NIPPV sequential therapy. A series of measures were taken,including psychological nursing given to the subjects and nurses,nursing during the application of NIPPV,observation and prevention of complications,disinfection,isolation,etc. We recorded RR,HR,pH, PaO2 ,PaCO2 ,SpO2 and OI of the subjects before and after treatment. Results The 4 subjects who were administrated with NIPPV during the whole treatment had alleviation in respiratory distress,and the 4 subjects who applied NIPPV after removing trachea cannula didn't have respiratory stress;three times of CDC test on throat swab showed H7N9 viral nucleic acid negative, after which quarantine was cancelled and all subjects were all discharged from hospital upon recovery. The pH and PaCO2 of the subjects after NIPPV treatment were not significantly different from those before treatment(P > 0. 05);after NIPPV treatment, the RR,HR and PaO2 of the subjects were lower than those before treatment,and SpO2 and OI were higher than those before treatment(P < 0. 05). Conclusion NIPPV can reduce the work of respiratory muscle and reduce the oxygen consumption of patients. It is an important method in the treatment of respiratory diseases. H7N9 severe avian influenza spreads mainly through contact or respiratory infection. Psychological nursing on nurses and patients,guidance on patients with the used of noninvasive ventilator and timely launch of emergency plans,such as disinfection and isolation are the key elements for the successful treatment of severe H7N9 avian influenza.