雾化吸入治疗的临床应用  

Clinical application of aerosol inhalation therapy

作　　者：温若譞 胡兴硕 解立新[1] WEN Ruo-xuan;HU Xing-shuo;XIE Li-xin(College of Pulmonary and Critical Care Medicine,Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]中国人民解放军总医院呼吸与危重症医学部,北京100091

出　　处：《中国实用内科杂志》2024年第12期989-994,共6页Chinese Journal of Practical Internal Medicine

基　　金：国家重点研发计划(2021YFC0122500)。

摘　　要：目前临床常用的几种雾化装置包括超声雾化器、喷射雾化器、压力定量气雾吸入器和振动筛孔雾化器等。其中超声雾化器雾化效果好,但药物主要作用于口咽部,临床应用受限;喷射雾化器临床应用广泛,但雾化效果略逊于其他雾化装置;压力定量气雾吸入器雾化效果好,但操作复杂;振动筛孔雾化器雾化效果最佳,但造价更高。随着雾化吸入治疗临床应用的不断推广,如何保证进行不同呼吸支持治疗的患者(如经鼻高流量湿化氧疗、有创和无创机械通气)雾化效果成为关键。与其他雾化装置相比,使用振动筛孔雾化器可以有效提高雾化效果。针对不同呼吸支持方式,雾化装置的安装位置各有不同。使用经鼻高流量湿化氧疗患者推荐将雾化装置放置在加湿罐入口处;对于机械通气患者,推荐根据有无基础气流将雾化装置放置在距呼吸机或Y型管15 cm处,以提高气溶胶肺内沉降率。但目前对于雾化效果的研究多为体外研究,随着未来的发展,相信雾化吸入治疗将会进一步规范,更加安全有效。Ultrasonic nebulizers,jet nebulizers,pressurized metered-dose inhalers,and vibrating mesh nebulizers are several commonly used nebulization devices in clinical practice.Ultrasonic nebulizers produce good nebulization effects but primarily act on the oropharynx,limiting their clinical application;jet nebulizers are widely used clinically but have slightly inferior nebulization effects compared to other devices;pressurized metered-dose inhalers offer good nebulization effects but are complex to operate;vibrating mesh nebulizers provide the best nebulization effects but are more expensive.As aerosol therapy continues to be widely applied clinically,ensuring the effectiveness of aerosol delivery for patients receiving different types of respiratory support(such as high-flow nasal cannula,invasive and non-invasive mechanical ventilation)has become a key issue.Compared to other nebulization devices,using vibrating mesh nebulizers can effectively enhance the nebulization effect.For different types of respiratory support,the position of placing nebulization devices varies.For patients using high-flow nasal cannula,it is recommended to place the nebulizer at the inlet of the humidifier tank;for mechanically ventilated patients,the nebulizer should be placed 15 cm away from the ventilator or Y-tube,depending on the presence of basal airflow,to improve aerosol deposition in the lungs.However,most studies on nebulization effects are conducted in vitro.With future developments,aerosol inhalation therapy will be further standardized,providing patients with safer and more effective aerosol inhalation treatment.

关 键 词：雾化吸入治疗 气溶胶沉降 机械通气 高流量氧疗 

分 类 号：R452[医药卫生—治疗学]