64例非体外循环冠状动脉旁路移植患者手术后低氧血症的监护

摘要

This paper summarized the nursing experience of postoperative hyoxemia for 64 patients after off-pump coronary artery bypass grafting. The key point of nursing went to cardiac function maintenance, ventilation management, bleeding monitoring and pain care, especially to the change of heart rate, blood pressure, central venous pressure, cardiac output, oxygen saturation and oxygenation index. Restrictive liquid management and negative fluid balance in early postoperative stage benefited the improvement of oxygenation especially for aged patients and those with poor cardiopulmonary function. Ventilation management including appropriate aspiration of sputum and warming humidification oxygen therapy also played a critical role. All patients recovered from hyoxemia except for one death.%总结64例非体外循环冠状动脉旁路移植患者手术后低氧血症的护理经验，认为心功能维护、呼吸管理以及出血监护和疼痛护理，是监护重点和难点。尤其要严密监测心率、血压、中心静脉压、心输出量、血氧饱和度和氧合指数的变化，及时掌握心功能和氧的供需平衡情况；实施限制性液体管理对策，术后早期保持轻度负平衡状态，特别对高龄、心肺功能较差的患者，以助于改善氧合；掌握低氧血症患者吸痰的正确方法，进行加温湿化氧疗，做到合理通气管理。经精心护理，63例低氧血症患者得以纠正，1例患者因重度低心排、低氧血症不能纠正而死亡。