两种高流量湿化氧疗在气管切开脱机患者中加湿性能的比较评价  

Humidification effects between humidifiers Venturi high-flow oxygen therapy and high-flow humidified oxygen therapy in treatment of tracheotomy patients after withdrawal of ventilator

作　　者：杨梅[1] 潘璐 钟晓燕 陈晖[1] 朱梅 王佳莹[1] 马丽标 成守珍[3] Yang Mei;Pan Lu;Zhong Xiaoyan;Chen Hui;Zhu Mei;Wang Jiaying;Ma Libiao;Cheng Shouzhen(Department of Intensive Care Unit,Shenzhen Second People's Hospital,Shenzhen,518000;Nanshan Centre for Disease Control and Prevention,Shenzhen,518000;Department of Nursing Administration,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,510080,China)

机构地区：[1]深圳市第二人民医院重症医学科 [2]深圳市南山区疾病预防控制中心,广东深圳518000 [3]中山大学附属第一医院护理部,广东广州510080

出　　处：《现代临床护理》2023年第12期9-16,共8页Modern Clinical Nursing

基　　金：广东省医学科学技术研究基金立项项目,项目编号A2022088;深圳市第二人民医院临床研究立项项目,项目编号20223357002。

摘　　要：目的比较两种不同高流量湿化氧疗方式在气管切开脱机患者应用的加湿性能,分析两种氧疗方式的加湿性能与患者气道湿化效果的关系,为气管切开脱机患者湿化氧疗方式的选择提供客观依据。方法选择2020年7月至2021年12月本市某三级甲等综合医院重症医学科(intensive care unit,ICU)的146例气管切开患者,将其随机分为试验组和对照组,分别73例。试验组使用文丘里高流量湿化氧疗装置(humidifiers Venturi high-flow oxygen therapy,HVHF)经气管切开导管进行高流量湿化氧疗,对照组使用呼吸湿化治疗仪(AIRVOTM2)经气管切开导管进行高流量湿化氧疗,两组设置同等条件的气体流速,对两组患者在高流量湿化氧疗0h、48h、7d和14d的近患者端气体的加湿性能指标绝对湿度、相对湿度、温度与痰液粘稠度、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial,PaCO_(2))、氧合指数(oxygennation index,PaO_(2)/FiO_(2))、肺部感染发生率指标进行比较。结果研究过程对照组脱落12例,试验组1例,对照组共完成61例,试验组共完成72例。两组患者重复测量方差分析结果显示,在不同时间点两组患者端气体绝对湿度、相对湿度、温度与患者PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)指标存在时间效应(均P<0.001),在不同时间点两组患者PaO_(2)、PaO_(2)/FiO_(2)指标不存在交互效应与组间效应(均P<0.001),而且试验组患者氧疗48h、7d、14d的PaO_(2)、PaO_(2)/FiO_(2)指标优于对照组;试验组患者48h、7d、14d痰液粘稠度优于对照组;试验组患者肺部感染发生率低于对照组,两组比较,差异具有统计学意义(均P<0.05)。结论两种高流量湿化氧疗装置HVHF和AIRVOTM2,在气管切开脱机患者高流量湿化氧疗的加湿性能相似,但HVHF在改善患者气道湿化效果、氧合效果及降低肺部感染方面优于AIRVOTM2,建议根据条�Objective To explore the humidification effects between the humidifiers Venturi high-flow oxygen therapy(HVHF)and the high-flow humidified oxygen therapy in the treatment of patients with tracheotomy after the withdrawal of ventilator,and analyse the humidification performance and effect of airway humidification on the two oxygen therapies hence to provide an objective basis for selection of a humidified oxygen therapy.Methods A total of 146 ICU patients who had tracheotomy and completely withdrawal of ventilator in a general hospital in Shenzhen from July 2020 to December 2021 were randomly divided into trial group(n=73)and control group(n=73).With identical speed of airflow,patients in the trial groups were treated with HVHF and the patients of control group were offered with high-flow humidified oxygen therapy via AIRVOTM2.Data of the two groups were compared at the time points of days 0,2,7 and 14 in terms of absolute humidity(AH),relative humidity(RH),temperature(T)),sputum viscosity,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FIO_(2))and the incidence of pulmonary infection.Results In the study,total of 61 patients in the control group and 72 patients in the trial group completed the high-flow humidified oxygen therapies,due to tubing detachments in 12 and 1 patients in the two groups,respectively.Repeated-Measures ANOVA analysis showed that,in both groups,there was a time effect(P<0.05)between the absolute humidity,relative humidity,temperature of the gas,PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)at different time points.PaO_(2)and PaO_(2)/FiO_(2)in both groups showed interactions at different time points(P<0.05).PaO_(2)and PaO_(2)/FiO_(2)in the trial group were better than those in the control group at the time points of days 2,7 and 14(P<0.05).On days 2,7 and 14,the viscosity of sputum in the intervention group was better than that in the control group,and the incidence of pulmonary infection in the trial group was significantly l

关 键 词：高流量湿化氧疗 文丘里高流量湿化氧疗装置 呼吸湿化治疗仪 气管切开 随机对照试验 

分 类 号：R473.5[医药卫生—护理学]