Abstract:

To summarize the perioperative nursing of respiratory care in 27 severely obese patients with acute type A aortic dissection. The mainly nursing points are as follows：active intervention for obesity hypoventilation syndrome and obstructive sleep apnea syndrome were conducted preoperatively，and a transient increase in intrathoracic and abdominal pressure were avoided. Intraoperative emergency care coordination for difficult airway was enhanced，and intensive lung function protection measures were implemented. Postoperative postural management was optimized；lung diaphragm protective strategies were carried out；progressive invasive-non-invasive step-down therapy was conducted to enhance ventilator endurance；lung infection surveillance was strengthened；early rehabilitation and psychological counselling were implemented. After careful treatment and nursing care，26 cases were cured and discharged from the hospital，and a case with difficulty in extrication was transferred to the respiratory rehabilitation hospital under tracheotomy.

Key words: Aortic Dissection, Obesity, Airway, Hypoxemia, Perioperative Nursing

摘要：

总结27例急性A型主动脉夹层重度肥胖患者围手术期呼吸道的护理经验。护理要点如下。术前积极干预肥胖低通气综合征及阻塞性睡眠呼吸暂停综合征；避免胸腹内压急剧升高。术中做好困难气道的管理及急救护理配合；落实集束化肺功能保护措施。术后优化体位管理；实施肺膈肌保护策略；采用渐进式降级脱机疗法，增强呼吸肌耐力；加强肺部感染的监控；开展早期康复及心理疏导。经过精心治疗与护理，26例痊愈出院，1例脱机困难予气管切开并转入呼吸康复医院。

关键词: 主动脉夹层, 肥胖, 呼吸道, 低氧血症, 围手术期护理