高海拔地区人工气道患者湿热交换器与超声湿化效果的比较研究  

A comparative study of humidification effect of wet heat exchanger and ultrasonic humidifier in patients with artificial airway in high altitude area

作　　者：李尊柱 德吉央宗[2] 李真 孙建华 孙红[3] 谢燕[2] 郭海凌 李奇 孙小南 Li Zunzhu;De Jiyangzong;Li Zhen;Sun Jianhua;Sun Hong;Xie Yan;Guo Hailing;Li Qi;Sun Xiaonan(Chinese Academy of Medical Sciences- Peking Union Medical College,Intensive Care Unit,Peking Union Medical College Hospital,Beijing 100730,China;Intensive Care Unit,Tibet Autonomous Region People′s Hospital,Lasa 850000,China;Chinese Academy of Medical Sciences- Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,100730 [2]西藏自治区人民医院重症医学科,拉萨850000 [3]北京协和医院护理部,100730

出　　处：《中国实用护理杂志》2019年第9期644-648,共5页Chinese Journal of Practical Nursing

基　　金：西藏自治区自然科学基金组团式援藏医学项目(XZ2017ZR-ZYZ21).

摘　　要：目的描述并比较高海拔地区西藏自治区人民医院重症医学科人工气道患者应用湿热交换器和超声的湿化效果。方法采用便利抽样的方法,选择2017年8-12月在西藏自治区人民医院收治的人工气道患者231例,按照入院时间先后顺序分为2组,湿热交换器组125例,在脱机过程中采用湿热交换器进行气道湿化。超声湿化组106例,在脱机过程中采用超声湿化器进行气道湿化。调查脱机24、48、72 h后,患者痰液黏稠度、痰痂形成情况、气道内的温度以及PaO2、PaCO2情况。结果湿化前、湿化后1 d、湿化后2 d、湿化后3 d,超声湿化组的Ⅰ度痰液比例分别为77.36%(82/106)、80.19%(85/106)、95.28%(101/106)、99.06%(105/106),湿热交换器组分别为99.20%(124/125)、99.20%(124/125)、95.20%(119/125)、72.80%(91/125),2组湿化前、湿化后1 d、湿化后3 d比较差异有统计学意义(χ^2=28.35、24.06、28.75,P<0.01)。湿化后湿热交换器组的PaCO2与超声湿化组比较差异无统计学意义(P>0.05),湿化后2、3 d湿热交换器组PaO2分别为(92.62±5.76)、(91.34±4.85)mmHg(1 mmHg=0.133 kPa),低于超声湿化组的(97.38±5.55)、(99.16±5.43)mmHg,2组比较差异有统计学意义(t=6.367、11.558,P<0.01)。湿热交换器组新出现的痰痂形成率更高,超声湿化组吸痰次数更高。结论高海拔地区湿热交换器和超声湿化各有优缺点,建议护士把握使用指征,动态评估湿化效果,以减少并发症的发生。Objective To describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude.MethodsThe patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission.A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process.In the ultrasonic humidification group,106 patients underwent airway humidification with an ultrasonic humidifier during weaning.After 24,48 and 72 hours offline,sputum viscosity,eschar formation,airway temperature,PaO2 and PaCO2 were investigated.ResultsBefore humidification,1 day after humidification,2 days after humidification and 3 days after humidification,the proportion of first degree sputum in the ultrasonic humidification group was 77.36%(82/106),80.19%(85/106),95.28%(101/106)and 99.06%(105/106),respectively.In the heat-moisture exchange group,99.20%(124/125),99.20%(124/125),95.20%(119/125),72.80%(94/125),respectively.There were differences between the two groups before,1 day and 3 days after humidification.There was statistical significance(χ^2=28.35,24.06,28.75,P<0.01).There was no significant difference in PaCO2 between the two groups(P>0.05).PaO 2 in the two and three days after humidification was(92.62±5.76),(91.34±4.85)mmHg,which was lower than that in the ultrasonic humidification group(97.38±5.55),(99.16±5.43)mmHg.There were significant differences between the two groups(t=6.367,11.558,P<0.01).There were significant differences between the two groups(t=6.367,11.558,P<0.01).ConclusionsThe rate of eschar formation was higher in the wet heat exchanger group,and the frequency of sputum suction was higher in the ultrasonic wetting group.

关 键 词：气道管理 护理 重症患者 痰液 湿化 

分 类 号：R472.2[医药卫生—急诊医学]