Pressing and keeping in touch with and treating the sleep to breathe and suspend the nursing _'s treatment of syndrome by the nose

Pressing and keeping in touch with and treating the sleep to breathe and suspend the nursing _'s treatment of syndrome by the nose
Pressing and keeping in touch with and treating the sleep to breathe and suspend the nursing of syndrome by the nose

China attends to the magazine Vol. 34 of number 7 of 1999 The training is attended to

Author: Ni JingHua Li Min Huang ShaoGuang Deng WeiWu

Unit: 200025 Shanghai is second medical university subsidiary Rui Jin hospital

Keyword: The obstructive sleep suspends syndrome; Pressing and keeping in touch with treating continuously through the nose; Nursing

SummaryBreathe and suspend syndrome (Obstructive Sleep Apnea Syndrom OSAS) in obstructive sleep The morbidity is higher and is sure dangerous illness potentially, from March of 1994 to November of 1997, our department is employing and pressing and keeping in touch with treating (Nasal Continous Positive Airway Pressure N-CPAP) continuously through the nose OSAS patient makes the result satisfiedly, the psychology when author's key report carries on N-CPAP treatment to OSAS patient is attended to, the importance of the skin care, explain are chosen pressure parameter and appropriate nose face guard rationally, it is CPAP that treats the key to success. Think N-CPAP treatment OSAS most frequently used most effective in patient at present, simple and convenient therapeutic method most one of.

Key wordsObstructive Sleep Apnea Syndrom Nasal Continous Positive Airway Pressure Nursing

Sleep breathe, it suspends syndrome to be morbidity high having, sure potential dangerous illness, in recent years, OSAS, this disease, is being known on clinic by people gradually, except it has typical snore, feel suffocated at night, have a liking for it outside symptom of sleeping etc. in the daytime, may return and hypertension, the emergence of diabetes has something to do.[1]And not caused and pay attention to enough yet to the treatment of this disease. With the development of medical science, launch, put on, connect with nose person who breathe go on, pigeonhole, keep in touch with, treat (N-CPAP) continuously abroad will it be middle period the eighties ,[2]Simple and convenient to save trouble, also can achieve the goal of treating method this, it suitable for, treat OSAS patient by family widely. Our department was employed and pressed and kept in touch with and treated OSAS patient continuously through the nose from 1994, treat 66 patients together by November of 1997, make satisfactory curative effect. 14 leading machine, patient of example, come back home to make long-term treatment in that.

A clinical materials

The total number of cases is 66, it is the obstructive sleep that breathes and suspends a syndrome patient, 39-66 years old, 56 of man, 10 of woman, 66 patient have typical symptom of OSAS, such as snore, it feels suffocated to be and sleepy to have a liking for, sleep on in daytime night, test, accord with diagnosis of OSAS by sleep, among them 2 once competent surgical palate swallow shaping the intersection of skill and treatment, postoperative symptom does not have obvious improvement, then do again and have no wound to press and keep in touch with treating continuously through the nose, choose type as SOLO CPAP System breathing machine, and it is good to use and organize compatibility, the nose face guard that white transparent colloidal silica made into, the helical colloidal silica silent stock tube links, locate in the patient's nose, then carry on N-CPAP treatment. Treat time average 4.6 2h.

2 operating sequences

2.1Will breathe the machine, the nose face guard, the colloidal silica silent stock tube and cable will be connected sequentially.

2.2Adjust the pressure, select the SOLO CPAP System type breathing machine for use, the range of its pressure is in 4- 15cmH2O. According to the intersection of adaptation and intensity of patient, by low to high, increase progressively progressively, observe blood and oxygen saturation lever closely at the same time, breathe the situation.

2.3Nose face guard and the patient's connection, fix with nylon four bandeaus or overseas caps, choose the appropriate nose face guard according to the facial shape of patient's nose, and locate the triangular foam cushion the bridge of the nose lightens some oppression, if a mouth breathing person can use the lower jaw to entrust at the same time.

3 attends to the measure

3.1Patient's psychological preparation, nurses must do a good job of explanation patiently and carefully, explain its purpose of application and method, what attentive matters of cooperating etc. to explain and use in course, in order to make the patient's understanding and cooperation, getting insufficient to confidence, we adopt lengthen duration, suit so as to patient progressively.

3.2Regulate the pressure parameter rationally, while doing CPAP treatment, carry on blood and oxygen saturation lever at the same time, and the monitoring of sleep index, in order to regulate the pressure parameter better, reach better therapeutic effect. The patients of this group complement and monitor and suspend the index (AHI) with the sleep appearance of the Model RHK-5500 at the same time in CPAP treatment ,Blood and oxygen saturation lever (SaO2),Make its AHI less than for 5 times h, SaO2Greater than more than 90%. Breathe, regulate initial pressure independently according to patient, from low-level to increase progressively until patient comfortable gradually regulate pressure, then heighten and more than 90% to the arterial oxygen saturation gradually according to the patient's monitoring situation, breathe and delay disappearing or reducing at the time of the sleep, the pressure parameter is usually from 4cmH2O begin, begin, can offer 15- 30min in order to suit just, advise patient to be calm to breathe, fall asleep, increase progressively until their comfortable to have no SaO progressively2Drop and breathe and suspend. 6 begin to have the fidgets during use, can't cooperate in the patients of this group, main suit sulk feel a pain, through instruct, advise patient relax, close one's eyes, calm to breathe patient, don't open one's mouth, transfer the pressure to 4cmH2O, transfers to 5cmH after 10min2O, transfers to 5.5cmH after 20min2It is transferred on the ground, until the patient goes to sleep peacefully, transfer the pressure to the necessary level of achieving the goal of treating that O is careful progressively. But still have 2 example because unable to tolerate, give up behind 2h, account for 3.03% that total treatment count. It is 6.5cmH that the patient CPAP therapeutic pressure values of this group are the lowest2O is at most 11cmH2O, average 8.75cmH2O.

3.3The choice and connecting of the nose face guard, the size of the nose face guard should change on the basis of face shape, choose the size to adapt to patient's face, and is relatively light to skin oppression, this group uses 48 M types, 18 S types, connecting the pipeline should prevent the damage from leaking gas.

3.4Keep the upper respiratory tract unobstructed, prevent cold, have a stuffy nose the patient uses 1: 1000 nitrofurazone ephedrine and one drop of noses.

3.5Find that leaks gas and deals with correspondingly in time, the patient tries hard to avoid a mouth breathing at the time of CPAP treatment, in case that it causes abdominal distension that the gas enters the gastrointestinal tract, can influence the therapeutic effect another, the person who has a mouth breathing uses the lower jaw to entrust, find the rubber tube damage of silicon is changed in time.

3.6The skin is damaged, it is that a nose face guard uses the comparatively common bad reaction in the course that the skin is damaged, mostly see on the bridge of the nose, skin of both sides of wing of nose, can be in the wing of nose, the triangular foam cushion is damaged in order to reduce the skin on the cushion between the bridge of the nose. Four bandeau or overseas cap bring elasticity to be appropriate while being fixed, should use patient that CPAP treat spare the intersection of petrolatum and ointment for a long time in addition, eyes lotion of aureomycin. This group has three example patient's taking machines that come back home to treat, happen red swelling of skin, have damage, advise, apply, stick to with the intersection of aureomycin and the intersection of eyes and lotion wound surface is light to rub some, the intersection of massage and face gently at inactive person who breathe, and nose carry sentence, impel blood circulation, can gauze or at affected part so as to lighten oppression, fully recover in one week after treatment foam-rubber cushion while using CPAP. Other cases because four bandeaus are fixed and appropriate, shut down, often massage the nose back, damage the skin.

4 brief summaries

After adopting CPAP to treat OSAS patient, the patient snores and disappears at the time of sleep, daytime is sleepy, have a liking for symptom of sleeping etc. and take a favorable turn, improve the patient's sleep quality, breathe hypoxemia disease suspended and caused and disappear or obviously take a favorable turn at the time of the sleep, it contributes to preventing hypertension caused by OSAS to employ for a long time, the artery high pressure of lung, the right heart is depleted, breathe the emergence of complication such as being depleted.[3]Its bitterness which does not have wound operation which has lightened the patient, it is easy and simple to handle secondly. Think it is one of OSAS patient's daily, effective, simple and convenient therapeutic method that N-CPAP keeps in touch with and treats at present.[3]In 66 patients of this group, 14 example patient's taking machines go home and treat for a long time, OSAS symptom obviously improved, follow up a case by regular visits to so far. Include 22 customary palate swallow shaping the intersection of skill and future trouble person, because postoperative symptom meet that take a favorable turn, and then through the intersection of CPAP and treatment, result prominent, leading machine come back home then. In that 2 example patients do not tolerate giving up, its reason may be, can't tolerate CPAP pressure. When the nose face guard pressurizes, the nose face pains, so it is CPAP therapeutic key to regulate the appropriate pressure and careful nursing of face guard of appropriate nose of choice.

References

A yellow mat is valued highly. Pressing and keeping in touch with and treating the obstructive sleep to breathe and suspend continuously through the nose. Chinese tuberculosis and breathing the magazine, 1991, 14(4) : 225.

2 Sulliyan C.E.Obstructive Sleep.Apne a Clinic Chest.Med,1985,6:663.

3 Wald Horm RE.Long term compliance with nasal continous posivive airway pressure therapy of obstruct ive sleep apnea.Chest,1990,97(1) : 33.

Accept the draft by 1998-06-07 1999-01-08 build, answer
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