肺心病患者昼夜病情变化特点及夜间护理对策

邱小文

摘要：目的　探讨肺心病患者昼夜病情变化的特点及护理对策。方法　观察50例缓解期肺心病患者的心率、心律、呼吸、SaO2、24 h动态心电图的昼夜变化情况，其中8例行24 h血流动力学监测。结果　50例患者夜间SaO2均下降，其中35例SaO2下降幅度大于10%，凌晨1:00～3:00 SaO2最低；凌晨0～4:00肺动脉压力为24 h中的最高值（54.1±24.3) mmHg；白天与夜间房性早搏发生率分别为(81.1±14.8)次/12 h及(207.4±81.6)次/12 h，20例白天无室性早搏的患者，夜间发生室性早搏，平均为(89.9±23.5)次/12 h，2例出现多形性及多源性室性早搏。结论　根据肺心病患者夜间SaO2明显下降、肺动脉压力明显升高、且心律失常发生率较白天明显高的特点，除延续夜间治疗外，加大夜间护理力度，特别是加强呼吸道管理，防止夜间SaO2下降,是提高肺心病患者生存质量、降低死亡率的关键之一。
关键词：肺心病； 病情变化特点； 夜间护理
中图分类号：R473.5　　文献标识码：A　　文章编号：1008-9993(2000)05-0005-03

Circadian Clinical Features of Patients with Cor Pulmonale and Nocturnal Nursing Strategy

QIU Xiao-wen
(Department of Nursing, Guangzhou General Hospital of PLA, Guangzhou 510010,China)

Abstract：Objective　To investigate the circadian clinical features of patients with cor pulmonale and provide nocturnal nursing strategy.Methods　Heart rate, rhythm, breathing rate, SaO2 and dynamic ECG were monitored in 50 patients with cor pulmonale. Of them, 8 underwent pulmonary hemodynamic monitoring. Results　Nocturnal decline in SaO2 was observed in all 50 cases. The level of SaO2 decreased more than 10% in 35 cases,the lowest level of SaO2 appearing at 1～3:00 a.m. and highest mPAP at 0～4:00 a.m.(54.1±24.3) mmHg.The occurrence of atrial premature beats in day time and at night was (81.1±14.8) and (207.4±81.6) times/12 h respectively. Twenty cases without ventricular premature beat in day time experienced ventricular premature beat at night with a average of (89.9±23.5) times/12 h .Multifocal and multiform ventricular premature beats were found in 2 cases. Conclusion　In view of significant decline of nocturnal SaO2, marked increase of mPAP and cardiac arrhythmia at night, in addition to the continuous nocturnal therapy, nursing at night should be intensified, especially in reference to the respiratory tract management;and prevention of decline of nocturnal SaO2 is the key t

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