睡眠呼吸暂停综合征患者夜间危险因素及护理对策

睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)是发病率高且有一定潜在危险的疾患。作者对16例SAS住院患者在治疗前、吸氧、气道持续加压(CPAP)呼吸机治疗不同状态下，进行整夜多导睡眠仪(PSG)监测，并进行分析，认为在SAS整夜呼吸紊乱中，零点以后其危险因素大大增加，出现严重低氧血症，血压升高，心律紊乱，尤其是呼吸暂停时间延长、次数增加。而吸氧及侧卧位可显著地改善低氧血症，最低血氧饱和度(SaO2)从62%±19%升高至83%±11%(P<0.01)，CPAP呼吸机治疗能使呼吸调节障碍得到明显的改善，呼吸暂停由44.3±22.6次降至0.28±0.54次(P<0.01)。由此提出护理上应密切观察病情变化，特别是零点以后应加强巡视，除观察呼吸运动外还应警惕脑血管病及心脏疾病的发生，CPAP呼吸机治疗时应加强心理护理及治疗期的护理，对不具备CPAP呼吸机治疗条件者宜采取夜间持续吸氧，在睡眠时督促取侧卧位。此外，对SAS患者进行健康教育是减少危险因素的重要护理措施。

AbstractObjective:To explore the nocturnal changes in sleep-respiratory variables in patients with sleep apnea syndrome (SAS) and nursing interventions in the comprehensive management of SAS.Methods:Sixteen SAS patients were evaluated for 3 separate nights:① night 1 involved a diagnostic polysomnography (PSG) study, and a further evaluation of the PSG recordings at three different time periods.②Oxygen treatment was carried out on night 2;and ③the patients were put on CPAP treatment on night 3.PSG study was repeated on night 2 and 3 respectively.Results:The risk factors increased progressively from time period 1 to time period 2 and time period 3.Oxygen saturation decreased significantly in time period 2 and 3 compared with time period 1.Both sleep position training and oxygen treatment resulted in a significant improvement in hypoxemia,the lowest saturation increased from 62%±19% to 83%±11%(P<0.01).With the treatment of CPAP,a significant improvement in sleep apnea index was also found (from 44.3±22.6 episodes/hour to 0.28±0.54 episodes/hour,P<0.01).Conclusions:The severity of sleep apnea might get worse progressively throughout the night and special attention should be paid to the later half of the night.SAS management involves multiple disciplines,among which nursing intervention is an important part and should not be neglected.

摘自 申萍李艳 睡眠呼吸暂停综合征患者夜间危险因素及护理对策