气管切开患者脱机期间不同湿化方式选择的研究  

A Comparisive Study of Different Airway Humidification Methods in Patients with Tracheotomy During Weaning Process

作　　者：陈凤佳[1] 李立君[1] 曾勉[1] 

机构地区：[1]中山大学附属第一医院内科ICU,广东广州510080

出　　处：《中国呼吸与危重监护杂志》2011年第5期474-477,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨气管切开患者脱机期间不同湿化方式的湿化效果。方法对中山大学附属第一医院内科重症加强治疗病房(MICU)2008年9月至2009年8月行气管切开的12例患者共进行45例次脱机试验,脱机试验期间采用三种不同的湿化方式。每组15例,A组采用湿方纱湿化,B组采用传统的间断滴入湿化液的方法,C组采用MR850湿化装置及RT200管道文丘理、合并T管装置进行湿化。比较各组湿化前后的痰液黏稠度,患者舒适度,观察每组脱机患者脱机时间,计算脱机期间痰枷形成的次数,脱机期间总呛咳次数,计算平均每小时发生的呛咳次数。采用气道分泌物评分(AWSS)评价痰液黏稠度。结果 A组湿化前后痰液黏稠度无显著差异(P>0.05),B组和C组AWSS评分较湿化前显著升高(P均<0.001),痰液的黏稠度显著下降,明显低于A组(P<0.05)。A组、B组和C组患者舒适度评分分别为(3.0±0.4)分、(5.0±1.2)分和(8.0±1.7)分,C组舒适度明显高于A组和B组(P<0.01);A组、B组和C组患者呛咳次数分别为0.8、2.6和0.4次/h,B组明显高于A组和C组(P<0.01)。A组15次的脱机记录中出现痰枷形成的次数为7次,明显高于B组和C组(P<0.01)。结论在气管切开患者脱机期间,相比传统的湿方纱法湿化或间断滴入湿化液的方法,采用MR850湿化装置及RT200管道文丘理、T管装置进行湿化更能降低痰液黏稠度减少痰枷形成,提高患者舒适度,减少刺激性呛咳的发生。Objective To compare the efficacy and safety of different air way humidification methods in patients with tracheotomy in weaning process.Methods Twelve patients with tracheotomy in the medical intensive care unit（MICU） of the First Affiliated Hospital of Sue Yat-sen University from September 20 0 8 to August 2009 were enrolled in which 45 case/times weaning tests in three dif ferent humidification ways were performed（15 cases in each group）.Wet square ga uze method was used in group A and traditional intermittent wet fluid drip metho d was used in group B.In group C,MR850 humidifier device,RT200 Venturi tube and T tube device were used to perform humidification.Comparisons were carried out between the three groups on sputum viscosity,comfort of patients before and af ter humidification,length of weaning time,frequencies of irritating coughs and phlegm formation during test period.Sputum viscosity was evaluated by airway se cretion score（AWSS）.Results There was no significant differ ence of sputum v iscosity assessed by AWSS in group A before and after humidification（P0. 05） while AWSS was significantly increased in group B and group C（P0.01）,i mplied that sputum viscosity was significantly lower than that of group A（P0. 05）. The scores of patients＇ comfort were 3.0±0.4,5.0±1.2,and 8.0±1.7 in gr oups A,B,and C respectively which mean that the patients in group C felt more comfortable than those in group A and group B（P0.01）.Cough frequencies of gro ups A,B and C per hour were 0.8,2.6,and 0.4 times/hour respectively in whi ch the frequency of group B was significantly higher than those of group A and grou p C（P0.01）.The frequency of phlegm formation in group A was 7 tim es in 15-times offline record,which was significantly higher than those in group B a n d group C（P0.01）.Conclusions For the patients with tracheotomy in weanin g process,MR850 humidifier device,RT200 Venturi tube and T tube device for hum idification is superior in reducing sputum viscosity and phlegm formati

关 键 词：气管切开 脱机 湿化 

分 类 号：R459.7[医药卫生—急诊医学]