Abstract: Nursing content of ltot: Oxygen inhalation is the basic method to treat various lung diseases complicated with hypoxemia. Indications of ltot: After treatment, the patients with chronic respiratory failure in the stable stage of chronic obstructive pulmonary disease have PAO 27.33 kPa (55 mmHg), or SA (O2) 88%, or PAO 27.33 ~ 9.33 kPa (50 ~ 70 mmHg) with secondary polycythemia (hematocrit 55%), pulmonary hypertension and cor pulmonale. Followed by patients with nocturnal hypoxemia. Ltot can correct the hypoxia state of patients with chronic hypoxia without obviously aggravating CO2 retention, slowing down the deterioration of lung function, reducing pulmonary artery pressure and delaying the progress of cor pulmonale. After 4-6 weeks of treatment, it can reduce hematocrit, reduce blood viscosity, increase cardiopulmonary oxygen supply, improve cardiac function and improve survival rate. However, ltot's disease can also bring discomfort to patients. The main reasons are not used to the way of oxygen therapy, not used to the taste of oxygen, affecting sleep, inconvenient movement and family economic difficulties. Therefore, our nurses should increase comfort, reduce noise, and improve the compliance of oxygen therapy, so as to ensure accurate, fast, safe and effective oxygen therapy care and bring psychological and physiological satisfaction to patients as much as possible, which makes ltot nursing more important and urgent. Paper content: Nursing oxygen inhalation in ltot is the basic means to treat various lung diseases complicated with hypoxemia. Indications of ltot: After treatment, the patients with chronic respiratory failure in the stable stage of chronic obstructive pulmonary disease have PAO 27.33 kPa (55 mmHg), or SA (O2) 88%, or PAO 27.33 ~ 9.33 kPa (50 ~ 70 mmHg) with secondary polycythemia (hematocrit 55%), pulmonary hypertension and cor pulmonale. Followed by patients with nocturnal hypoxemia. Ltot can correct the hypoxia state of patients with chronic hypoxia without obviously aggravating CO2 retention, slowing down the deterioration of lung function, reducing pulmonary artery pressure and delaying the progress of cor pulmonale. After 4-6 weeks of treatment, it can reduce hematocrit, reduce blood viscosity, increase cardiopulmonary oxygen supply, improve cardiac function and improve survival rate. [1] However, ltot also brings discomfort to patients. The main reasons are not used to the way of oxygen therapy, not used to the taste of oxygen, affecting sleep, inconvenient movement and family economic difficulties. Therefore, in ensuring accurate, fast, safe and effective oxygen therapy nursing, our nurses can increase comfort, reduce noise, improve and improve the compliance of oxygen therapy, bring psychological and physical satisfaction to patients as much as possible, and make ltot nursing more important and urgent. 1. Health education of oxygen therapy 1. 1 Oxygen therapy should belong to a drug therapy, but people underestimate the ability of oxygen to treat hypoxemia, and if it is administered improperly, it will lead to death. Our nurses should understand the methods of oxygen supply and the purpose of patients' oxygen inhalation, and also teach patients how to receive correct, safe and comfortable oxygen therapy, understand the basic knowledge of oxygen use, matters needing attention in use, explain possible problems, and understand the significance of arterial blood gas analysis and arterial oxygen saturation. Strengthening the popular science education of oxygen therapy runs through the whole process of oxygen therapy nursing 1.2 Safety guidance should strengthen patients' awareness of safe use of oxygen. Oxygen itself will not burn, but it is a combustion-supporting gas. Pay attention to heat, fire, oil and electric shock when using. Smoking is strictly prohibited in the ward. When using oxygen cylinders, check the pressure of oxygen at any time, and change bottles when it is lower than 5Mpa to avoid danger when inflating. Purpose of oxygen supply 1.3 It is very important to provide proper oxygen therapy for patients with dyspnea. If you receive high concentration of oxygen, some patients with hypoxia may die. For example, patients with chronic obstructive pulmonary disease can't inhale high-concentration oxygen, because patients' sensitivity to carbon dioxide in blood is reduced, and hypoxia in blood can stimulate the respiratory center more than carbon dioxide. If you inhale high concentration of oxygen at this time, it will inhibit the respiratory center, leading to carbon dioxide retention and even death. 1.4 Strictly implement the concentration of oxygen therapy. Long-term high concentration will cause oxygen poisoning, respiratory depression and other side effects. Studies have shown that if the oxygen concentration is controlled in the range of 24%-28%, even if the course of treatment exceeds 10 years, oxygen poisoning will not occur. [2 3] For patients who need ltot, the longer they receive oxygen therapy every day, the higher the curative effect, but it is unrealistic to take oxygen for 24 hours. At present, it is agreed that oxygen inhalation at least 15 hours a day can make the arterial oxygen partial pressure greater than 8.0kPa, so as to obtain the effect of oxygen therapy. [4] Nurses often find that patients increase the oxygen flow without authorization when they patrol the ward at night, thinking that this can improve the symptoms of hypoxia. Some patients refuse oxygen therapy after the symptoms of hypoxia have improved slightly. This kind of wrong behavior should be stopped in time to make patients understand, so education in this area is particularly important. 2. Selection of oxygen supply catheter 2. 1 Disposable single-lumen oxygen supply catheter (nasal plug type) This oxygen supply catheter has obviously less stimulation to nasal mucosa than the previous oxygen supply method of nasal catheter, but it is not easy to fix, and fixing with tape affects the appearance and causes skin discomfort. 2.2 Disposable single-cavity oxygen inhalation catheter (nose hook type) This oxygen inhalation catheter makes up for the above points. It uses soft plastic to block the nose wing, so that the catheter is not easy to fall off. The disadvantage is that the single-cavity oxygen inhalation catheter can concentrate the oxygen flow on one nostril, and the soft plastic blocks the nostril, which can make the nasal mucosa congested and swollen for a long time and reduce oxygen therapy. 2.3 Disposable double-cavity oxygen inhalation catheter (earmuff type) It has two vent holes, and two nasal plugs are inserted into the nostrils to disperse the oxygen flow, so that the nasal catheter can be worn on the ear when wearing glasses. The length of the piston can be adjusted according to the length of the patient's face to increase stability and comfort. The research shows that there is no significant difference in respiration, pulse and oxygen saturation after the above three oxygen supply methods. [5] 2.4 Disposable mask oxygen inhalation catheter (elastic band type) mask oxygen supply has no irritation to the airway mucosa of patients, and it is well fixed, with large oxygen flow and high oxygen concentration. The disadvantage is that conscious patients feel suffocated [6], which hinders communication and is not convenient for coughing and expectoration. It can be seen from the above that disposable double-lumen oxygen inhalation catheter is the first choice for ltot patients. 3. Reduce the noise caused by oxygen inhalation. Principle 3. 1: Make the big bubbles entering the oxygen humidification bottle become multiple small bubbles, and the openings are aligned with the bottle wall. Under the action of gravity, the impact of small bubbles on the bottle wall is obviously reduced, and finally the noise is eliminated. 3.2 Method: First, take 1cm from the neck of Kaisailukong Capsule, cut off the rest, and use No.7 needle to make small holes (except the bottom) in the balloon, with a uniform size and a spacing of 2cm, and disinfect for later use. Connect the plug dew with a 3cm pressure belt to the lower end of the ventilation pipe in the humidifying bottle, and the rest are carried out according to the routine operation of oxygen inhalation. [7] 3.3 CoCo Lee [8] and others also improved the oxygen humidification bottle: take a cylindrical sponge column with a length of 5.5cm, a cross-sectional diameter of 4cm, a hollow center, a length of 3.5cm, and a cross-sectional diameter of 1.5cm, and put it into the humidification bottle so that the hollow of the sponge column is sleeved on a long tube in the humidification bottle. Sponge is cleaned and disinfected once a week 1 time, soaked in 2% glutaraldehyde solution for 15 minutes, then washed with distilled water and dried for later use. Before and after they improved the oxygen humidification bottle, the noise was reduced when inhaling oxygen with different flow rates. This can eliminate the noise caused by oxygen inhalation and ensure the quiet rest environment of ltot patients at night. 4. Pay attention to the influence of oxygen heating humidification 4. 1 Diao Shangzhi [9] on the curative effect of electronic temperature-controlled oxygen humidifier on patients with acute COPD. The results show that heating humidified oxygen can smoothly discharge airway secretions, prevent the occurrence or aggravation of small airway obstruction and obstructive bronchitis, and improve clinical symptoms. Humidified sputum cilia are easy to move and expectoration is obviously accelerated. Mucosal humidification is beneficial to the regression of inflammation and the airway patency rate is obviously improved. 4.2 For patients who want to undergo ltot, the temperature of oxygen inhalation is 37C and the humidity is about 80%. In a humidified bottle, warm water of 50-70C reaches 1/3- 1/2 of the volume of the bottle, and it is changed every day. You can also punch two small holes with a thermos bottle stopper, and fill 4/5 bottles of 50-70C warm water in the bottle, depending on the humidification of the oxygen inhalation device.