不同氧气连接方式对无创正压通气吸入氧浓度的影响  

The influence of oxygen delivery method on the level of FiO_2 during noninvasive positive-pressure ventilation

作　　者：袁月华[1] 徐培峰[1] 葛慧青[1] 徐诗行 侯斌[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院呼吸治疗科,杭州市310016

出　　处：《中华护理杂志》2014年第6期654-657,共4页Chinese Journal of Nursing

摘　　要：目的了解无创正压通气(NPPV)时吸入氧浓度随着连接方式改变的变化规律。方法建立实验室模型,氧气分别通过呼吸机出口端、漏气阀端和无创面罩端3种连接方式给氧,测量在给氧流量分别为2L/min、5L/min、10L/min时,面罩内所得氧气浓度;根据实验室结果,纳入9例需进行NPPV的慢性阻塞性肺疾病急性发作期(AECOPD)患者进行临床观察验证,分别轮换使用3种连接方式进行供氧,观察患者氧合情况及其对氧流量的需求。结果实验室研究显示,经呼吸机出口端和面罩端给氧的氧浓度总体较经漏气阀端给氧高;经呼吸机出口端和面罩端两种连接方式的氧浓度并无明显差异,但经呼吸机出口端给氧要比经面罩端给氧所得氧浓度变化区间小,经漏气阀端给氧可以得到最小变化区间的氧浓度。临床观察患者在使用经呼吸机出口端和经面罩端给氧时所需的氧流量明显比经漏气阀端给氧低;经呼吸机出口端和经漏气阀端给氧时患者的脉搏血氧饱和度(SpO2)较经面罩端给氧时稳定;患者所需的送气压力越高,所需氧流量越大时,SpO2就越不稳定。结论外接氧源行NPPV时,不同的氧源连接方式和给氧流量大小会影响所得氧气浓度;在呼吸机所给压力较高或者患者所需氧流量较大时,经呼吸机出口端供氧可以提供较稳定的氧气浓度,保证患者稳定的氧合。Objective To investigate the influence of oxygen delivery method on the level of FiO2 during nonin- vasive positive-pressure ventilation（NPPV）. Methods Firstly,the experiment of three methods of oxygen delivery was done in the lab. The oxygen was delivered by the ventilator exit the leak valve and the mask,respectively. The level of FiO2 was measured when the oxygen flow was 2L/min,5L/min and10L/min in the three oxygen delivery modes. Then,a clinical study was conducted on 9 chronic obstructive pulmonary disease（COPD） patients during NPPV. Results When all other variables were constant,FiO2 and the variation range increased with the increase of oxygen flow. The level of FiO2 was higher when the oxygen was delivered by the ventilator exit and the mask. The level of FiO2 was lowest but most stable when the oxygen was delivered by the leak valve. The clinical study showed that the oxygen flow was lower when the oxygen was delivered by the ventilator exit and the mask than the leak valve. The patients＇ pulse oxygen saturation（SpO2） was much more stable by the ventilator exit and the leak valve than the mask. When patients need the higher gas pressure and oxygen flow,the SpO2 was more unstable. Conclusion When using supplemental oxygen during NPPV,the oxygen delivery method and oxygen flow can influence the level of FiO2. When the patients need higher gas pressure or oxygen flow,the FiO2 is more stable when the oxygen is delivered by the ventilator exit.

关 键 词：通气机 机械 氧吸入疗法 临床护理研究 

分 类 号：R472[医药卫生—护理学]