人工气道患者脱机后湿化氧疗的最佳实践策略  

The best practice strategy of humidification oxygen therapy for patients with artificial airwayduring weaning from ventilation

作　　者：李霞[1] 张传来[1] 郑秋兰[1] Li Xia, Zhang Chuanlai, Zheng Qiulan(Intensive Care Unit, the Second AffiliatedHospitalofChongqing Medical University, Chongqing 400010, Chin)

机构地区：[1]重庆医科大学附属第二医院重症医学科,400010

出　　处：《中国实用护理杂志》2018年第9期690-694,共5页Chinese Journal of Practical Nursing

摘　　要：目的探讨人工气道患者脱机后至拔管期间的最佳氧疗湿化策略，以提高氧疗效果，降低带管时间及感染的发生率。 方法以重庆医科大学附属第二医院重症医学科2016年3-12月行人工气道脱机氧疗的133例患者为研究对象，采用随机抽签法将其分为试验组69例和对照组64例，试验组脱机后采用＂文丘里＋加热湿化器＋呼吸机管道改良组合装置＂的氧疗温湿化策略，对照组脱机后采用常规气管导管内吸氧加持续微量泵泵入0.45%氯化钠溶液的人工气道湿化氧疗法，比较2组患者心率、呼吸、血氧饱和度、脱机后带管时间、脱机失败、痰液黏稠度、痰痂形成、呛咳和肺部感染情况。 结果试验组患者的心率、呼吸频率、血氧饱和度、脱机后带管时间分别为（80.50 ± 7.07）次/min、（17.38 ± 1.92）次/min、0.98 ± 0.01、（1.58 ± 1.06）d，对照组分别为（88.50 ± 3.07）次/min、（21.38 ± 1.51）次/min、0.96 ± 0.01、（3.00 ± 1.09）d，2组比较差异有统计学意义（t=2.268~4.782，均P〈0.05或0.01）；试验组发生脱机失败、痰痂形成、刺激性呛咳和肺部感染分别为2、3、4、4例，对照组分别为8、12、20、12例，2组比较差异有统计学意义（χ2=4.652~14.545，均P〈0.05或0.01）；试验组痰液的湿化效果中Ⅰ、Ⅱ、Ⅲ度痰液黏稠度分别为5、52、12例，对照组分别为13、11、40例，试验组明显优于对照组，差异有统计学意义（Z=3.385，P〈0.01）。 结论改良后的氧疗湿化策略既能够维持气道有效的温湿化，保证氧疗效果，还能提高脱机成功率，减少带管时间和感染的发生，提高患者的舒适度。ObjectiveTo explore the better humidification oxygen therapy for patients with artificial airway from weaning to extubation, ensure the best humidification effect, keep airway unobstructed, shorten tubulization time and reduce the incidence of infection. MethodsA total of 133 patients with artificial airway during weaning from ventilation admitted from March to December in 2016 in intensive care unit of the Second Affiliated Hospital of Chongqing Medical University were included in the study. They were divided into the experimental group （69 patients） and the control group （64 patients） by random lottery form. The experimental group was given improved combination device （venturi, heated humidifier and ventilator tube）during oxygen therapy for humidification and heating, while the control group was treated with oxygen therapy in endotracheal tube and continuous wet micro-injection pump 0.45% sodium chloride method. The heart rate, respiratory rate, blood oxygen saturation, offline time with tube, offline failure rate, sputum viscosity, sputum scab formation, irritant cough and pulmonary infection were compared between the two groups. ResultsThe heart rate, respiratory rate, blood oxygen saturation and offline time with tube in the experimental group were （80.50±7.07） times/min, （17.38±1.92） times/min, 0.98±0.01, and （1.58±1.06） days, and which were （88.50±3.07） times/min, （21.38±1.51） times/min, 0.96±0.01 and （3.00±1.09） days in the control group. The differences were statistically significant （t = 2.268-4.782, P 〈 0.05 or 0.01）. The offline failure （2 cases）, sputum scab formation （3 cases）, irritant cough （4 cases） and pulmonary infection（4 cases） were less than 8 cases, 12 cases, 20 cases,12 cases in control group. The differences were statistically significant （χ2=4.652-14.545, P 〈 0.05 or 0.01）. The sputum viscosity of Ⅰ, Ⅱand Ⅲ were 5 cases, 52 cases and 12 cases in the experimental group, which were better than 13 cases, 11

关 键 词：气道管理 人工气道 脱机患者 气道湿化 氧气吸入疗法 

分 类 号：R472[医药卫生—护理学]