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    適時護理干預對嬰幼兒霧化吸入的影響
    關鍵字:影響,干預,護理,適時,IJ,KL,EF,CD,yz,AB, 發布時間:2011-08-20

    贛南醫學院學報 2010年 過度彎曲、伸展,以免導管滑脫,注意導管的保護,講 解置管側手臂的負重要求、穿脫上衣方法及帶管沐 浴的方法等。 3.3便攜式化療泵的護理 便攜式化療泵是一種 輕便的一次性輸注裝置,采用彈性藥囊,以持續彈性 壓力推動液體輸入,藥囊的最大容量為300mL,臨 床上一般采用為2d(48h)的泵或者是5d(120h) 的泵,2d泵輸液量為5mL/d,5d泵輸注量為 2mL/d,需要的總液體量為240mL【4J。 3.3.1容量要汁算準確,配藥技術應嚴謹。加藥時 嚴格遵守無菌操作原則,嚴禁注人空氣以免空氣輸 入膠囊內以至過量,使囊內壓力增加引起膠囊爆裂 或影響輸液時間,防止將空氣輸入體內。 3.3.2保證正確的使用方法①輸注泵與PICC 連接時,不可使用頭皮針連接,囚頭皮針的硅膠較 軟,容易反折影響流速;②持續輸液期間,患者可自 由行走及活動,但盡量使藥囊與靜脈穿刺處保持在 同一水平線,以保證流速精確;③輸液過程中,護士 要加強巡視,觀察化療泵的使用狀態、輸液的速度及 剩余量,及時排除影響流速的不良因素,建立班班交 接的化療泵活動觀察卡,正確推算出終止時間,并詳 細交班。 4討論 采用便攜式化療泵持續化療,不僅能勻速、精確 地將藥物泵人患者體內,維持恒定的血藥濃度,最大 限度殺死腫瘤細胞,而且可攜帶活動,解決了傳統輸 液需長時問臥床對日常生活的影響,下床活動還有 助于改善由化療引起的便秘,提高了患者的生活質 量。本組67例消化道腫瘤患者使用便攜式化療泵 加PICC導管治療,經規范治療與精心護理,無l例 發生藥物外滲性損傷及藥物性靜脈炎,有效地解決 了化療藥物外滲引起的血管損傷和疼痛,同時在便 攜式化療過程中,病人不良反應減輕,全部病例均能 順利完成全程化療,使消化道腫瘤患者獲得最佳療 效,提高了生活質量。 參考文獻: [1]李振.惡性腫瘤的化學治療與免疫治療[M].北京:人 民衛生出版社,1990:99—100. [2]張靜.PICC在內科重癥監護室的應用及觀察[J].護士 進修雜志,2002,17(10):785. [3]張惠蘭,陳榮秀.腫瘤護理學[M].天津:天津科學技 術出版社,1999:497. [4]李黎,馬新樂,孫廣榮.便攜式化療泵配合PLCC持續 給藥的護理[J].中國誤診學雜志,2005,5(8):1533— 1534. (收稿日期:2010—05—04) 適時護理干預對嬰幼兒霧化吸入的影響 王香香 (贛州市婦女兒童醫院兒科,江西贛州341000) 摘要:目的:探討適時護理干預對嬰幼兒霧化吸入的影響。方法:將272例行霧化吸入的支氣管肺炎的嬰幼兒 隨機分成觀察組(138例)和對照組(134例),對照組按常規霧化吸入,觀察組在霧化吸人過程中行護理干 預,觀察兩組霧化治療中出現嘔吐,呼吸急促,面色青紫,痰液堵塞呼吸道,鵝口瘡發生率。結果:觀察組霧化吸入 中嘔吐、呼吸急促、面色青紫、痰液堵塞呼吸道、鵝口瘡等不良反應發生率,顯著少于對照組(P<0.01)。結論:適 時護理干預能減少嬰幼兒霧化吸人的不良反應。 關鍵詞:嬰幼兒;霧化吸入;護理干預 中圖分類號:R473.72文獻標志碼:A文章編號:100l一5779(20zo)04—0654一02 霧化吸人將藥液以氣霧的形式,經氣管直到肺 部病變部位,其作用直接,起效迅速,效果好。同時 避免了對非病變部位的影響。霧化吸入已廣泛用于 嬰幼兒呼吸系統疾病,特別是小兒支氣管肺炎應用 更為廣泛。但由于霧化過程中患兒及藥物因素常出 現一些不良反應。如嘔吐、呼吸急促、面色青紫、痰 液堵塞呼吸道、鵝口瘡等,直接影響霧化吸人的效 .--——654?--—— 果,同時給患兒帶來痛苦。筆者對引起不良反應的 相關因素進行了分析并適時進行護理干預,取得了 良好的效果,現報道如下。 1資料與方法 1.1一般資料選擇2008年11月~2009年5月 我科收治的支氣管肺炎患兒272例,隨機分成觀察 萬方數據 換頁 4期王香香適時護理干預對嬰幼兒霧化吸人的影響 組138例,對照組134例。觀察組男83例,女55 例,年齡(0.61±0.24)歲,霧化次數(8.01±2.12) 次。對照組男78例,女56例,年齡(0.58±0.26) 歲,霧化次數(7.62±2.5"/)次,兩組性別、年齡、病 情、霧化吸入的次數比較,差異無顯著性意義(P> 0.05)。 1.2方法兩組在抗炎,平喘等藥物治療的基礎上 進行霧化吸人。霧化藥液遵醫囑:生理鹽水10mL +糜蛋白酶(或沐舒坦)+地塞米松+病毒唑。對 照組按常規霧化吸人治療…。觀察組在霧化吸入 過程中行護理干預。霧化前:把霧化吸入的具體時 間告訴陪護人員,囑霧化前30min不進食,評估患 兒口腔、鼻腔分泌物,必要時吸痰,清除口腔咽部分 泌物,霧化時:患兒取坐位或半坐位。密切觀察患兒 呼吸,面色。如患兒哭鬧不安,呼吸加快,面色青紫, 暫停霧化吸入,排除了痰液堵塞呼吸道后,行間歇霧 3討論 化吸人。即霧化吸入時間與間歇時間交替。霧化 后:即用毛巾擦拭面部,觀察口腔粘膜,用溫開水漱 口或用生理鹽水行口腔護理,清除面部及口腔內的 殘留藥物。 1.2.1觀察指標觀察兩組霧化治療中出現嘔吐. 呼吸急促,面色青紫,痰液堵塞呼吸道,鵝口瘡發生 率。 1.2.2統計方法將數據進行X2檢驗。 2結果 表1顯示,觀察組霧化吸人中嘔吐、呼吸急促、 面色青紫、痰液堵塞呼吸道、鵝口瘡等不良反應發生 率,顯著少于對照組(P<0.01),說明適時護理干預 能減少霧化吸人的不良反應。 表l兩組不良反應發生情況比較例(%} 3.1引起霧化中嘔吐的原因有:①霧化藥物在稀 釋痰液,消炎,解痙作用同時,對咽喉部有一定刺激 作用。②嬰兒霧化過程中哭鬧不安,口腔分泌物刺 激咽喉。③嬰幼兒進食不定時,特別是行人工喂養 及母乳喂養的嬰兒如飽食后即行霧化吸人,或取側 臥位行霧化吸入易引起胃食道返流。及時清除口 腔分泌物減少對咽喉的刺激。取半坐位或坐位,避 免霧化前進食,可以減少胃食道返流而致的嘔吐。 3.2密切觀察患兒呼吸,面色,如患兒哭鬧不安, 呼吸加快,面色青紫,立即暫停霧化吸入,排除痰液 堵塞呼吸道后,可采用間歇霧化吸人法,一方面,嬰 幼JLN炎時,炎性滲出物增多,肺泡內水分壓增加, 氧分壓相應減小心’;另一方面,常規霧化吸人法會 短時間內使肺泡內水分壓進一步增加,氧分壓急劇 下降,易導致不同程度的低氧血癥。呼吸心率代償 性增加,甚至出現一過性肺水腫或呼吸困難,間歇 霧化吸人法,可以使肺泡內氧分壓維持在平衡狀 態,緩解低氧血癥的發生,而且使呼吸,心率,血氧 飽和度始終維持在一個較正常的范圍內,避免了不 良反應的發生p 3。 3,3地塞米松是一種糖皮質激素,雖然局部用藥 大大下降低藥物的不良反應。但如果較長時聞對口 腔粘膜、咽喉刺激,可引起鵝口瘡,聲音嘶啞r4】。 及時清除局部藥物殘留,可避免鵝口瘡、聲音嘶啞 等現象發生。 3.4呼吸道通暢是吸入藥物發揮作用的前提。由 于嬰幼兒氣管、支氣管較狹小,缺乏彈力組織保護, 纖毛運動差,粘膜血管豐富,易于感染,感染后粘膜 充血,水腫,滲出,加重呼吸道堵塞。粘膜表面分泌 物增多直接影響藥物的吸收,分泌物阻塞呼吸道霧 化藥物不能很好的吸入肺部達不到治療目的。霧 化前清除呼吸道分泌物,更利于藥物的全面吸收, 同時避免霧化過程中發生痰液堵塞呼吸道現象的 發生。 參考文獻: 【1]殷磊.護理學基礎[M].第3版.北京:人民衛生出版 社。2002:342. [2]燕敬菊,楊國玉,超聲霧化吸入療法在下呼吸道先性 疾病治療中的應用[J].山東醫藥,2002,42(25):35— 36. ‘ [3]張秀萍,朱梅,廉德花.不同霧化吸人療法對嬰幼兒肺 炎排痰效果影響的研究[J].中國實用護理雜志, 2006,22(2):33—34. [4]陳育智,趙京.兒童支氣管哮喘的診斷及治療[M].北 京:人民衛生出版社,2004:132—133. (牧稿日期:2010—03~02) ?。一655-—~ 萬方數據 換頁

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