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国际临床研究杂志

International Journal of Clinical Research

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International Journal of Clinical Research. 2024; 8: (2) ; 10.12208/j.ijcr.20240039 .

The treatment and management of overweight patients in ICU: Practice and experience
超重患者的ICU管理:实践与经验

作者: 周贝柠, 郑璇 *, 夏俊琳, 汪蓉

湖北医药学院附属十堰市太和医院 湖北十堰

*通讯作者: 郑璇,单位:湖北医药学院附属十堰市太和医院 湖北十堰;

引用本文: 周贝柠, 郑璇, 夏俊琳, 汪蓉 超重患者的ICU管理:实践与经验[J]. 国际临床研究杂志, 2024; 8: (2) : 19-23.
Published: 2024/2/22 21:11:06

摘要

目的 本文旨在探讨超重患者在重症监护病房(ICU)中的管理问题,通过总结湖北医药学院附属十堰市太和医院对25名超重患者的治疗管理经验,提炼出有效的护理方法,为其他医护人员提供参考,以更好地治疗与护理超重患者。方法 本文采用了回顾性分析的方法,对25名超重患者在ICU中的治疗管理进行了总结。详细记录了患者的基本资料、ICU监护治疗与护理的具体措施,包括心脏及血流动力学监测、呼吸系统管理、血管通路的建立、适当的药物治疗方案和营养支持等。结果 通过对25名超重患者的治疗管理经验进行总结,本文提炼出了有效的护理方法。在心脏及血流动力学监测方面,提出了使用大号血压袖带、超声辅助导管置入等措施;在呼吸系统管理方面,强调了机械通气的初始潮气量设置、气道平台压的维持以及肺部物理治疗的重要性。此外,本文还指出了超重患者管理面临的挑战,如提供适合的医疗/护理服务、适当的设施以及医疗保健辅助人员的培训等。结论 超重患者在ICU中的管理是一项具有挑战性的任务,需要医护人员采取有效的护理方法。通过总结太和医院的治疗管理经验,本文为其他医护人员提供了参考,有助于更好地治疗与护理超重患者。然而,关于如何最有效地护理肥胖患者,目前仍需要更多的研究和探讨,以制定统一的标准或指南。

关键词: 超重患者;重症监护;ICU管理;实践;经验

Abstract

Objective This paper aims to explore the management of overweight patients in intensive care unit (ICU), by summarizing the experience of treatment and management of 25 overweight patients in Taihe Hospital affiliated to Hubei University of Medicine, and extract effective nursing methods, so as to provide reference for other medical staff to better treat and care for overweight patients.
Methods A retrospective analysis was used to review the management of 25 overweight patients in ICU. The patient's basic information, ICU monitoring and nursing measures were recorded in detail, including cardiac and hemodynamic monitoring, respiratory system management, vascular access establishment, appropriate drug therapy and nutritional support.
Results Through the summary of the treatment and management experience of 25 overweight patients, this paper refines the effective nursing methods. In terms of cardiac and hemodynamic monitoring, large blood pressure cuff and ultrasound-assisted catheter placement were proposed. In terms of respiratory system management, the importance of initial tidal volume setting for mechanical ventilation, maintenance of airway plateau pressure and pulmonary physical therapy were emphasized. In addition, the paper identifies the challenges of managing overweight patients, such as the provision of appropriate medical/nursing services, appropriate facilities, and training of healthcare support staff.
Conclusion   The management of overweight patients in ICU is a challenging task that requires effective nursing methods. By summarizing the treatment management experience of Taihe Hospital, this paper provides a reference for other medical staff, which is helpful to better treat and care for overweight patients. However, there is still a need for more research and discussion on how to most effectively care for obese patients to develop uniform standards or guidelines.

Key words: Overweight patients; Intensive care; ICU management; Practice; EXP

参考文献 References

[1] Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020.

[2] 张婉月,孙振涛. 不同潮气量复合驱动压滴定PEEP对腹腔镜直肠癌根治术超重患者心肺功能的影响[J]. 河南外科学杂志,2023,29(3):56-60.

[3] 周玲玲,任浩璇,马鹰翔. 强化呼吸系统护理在老年超重非体外循环冠状动脉旁路移植术患者中的应用[J]. 国际护理学杂志,2020,39(16):3050-3052.

[4] 张潇潇. 老年重症监护室糖尿病患者血糖难控制的原因分析及护理对策[J]. 糖尿病新世界,2017,20(24):128-129.

[5] 李沛函,李丽,杨彦伟,等. 超重患者行无痛胃镜麻醉中舒芬太尼和丙泊酚最佳给药时间间隔的临床观察[J]. 临床和实验医学杂志,2020,19(13):1362-1364.

[6] 范婷泳,袁丽. 体重指数和中心性肥胖与复发性静脉血栓栓塞关系的meta分析[J]. 心血管病学进展,2022, 43(6):559-565.

[7] El-Solh AA. Clinical approach to the critically ill, morbidly obese patient. Am J Respir Crit Care Med 2004; 169:557.

[8] Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet 2010; 49:71.

[9] Brill MJ, Diepstraten J, van Rongen A, et al. Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet 2012; 51:277.

[10] Erstad BL. Dosing of medications in morbidly obese patients in the intensive care unit setting. Intensive Care Med 2004; 30:18.