协和医学杂志

2013, v.4(03) 282-285

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加温湿化吸氧技术对气管插管患者拔管前的气道管理效果
Application of Warming Humidification and Atomization Inhalation Technique for Patients with Endotracheal Intubation before Extubation

华小雪;周文华;高健;绳宇;孙红;
HUA Xiao-xue 1 ,ZHOU Wen-hua 1 ,GAO Jian 1 ,SHENG Yu 2 ,SUN Hong 3 1 Department of Emergency, 3 Department of Nursing,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2 School of Nursing,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的评价机械通气患者实施T管脱机阶段使用加温器进行热湿化的气道管理效果。方法将60例使用有创机械通气、经治疗后具备脱机指征的重症患者用简单随机法分为T管脱机组(对照组,30例)和T管加温器脱机组(研究组,30例),对照组使用T管连接可调节输液器,控制湿化液速度,研究组在对照组的基础上,使用加温器置于可调节输液器距T管10cm处,进行加温湿化。观察两组患者痰液黏稠度、刺激性咳嗽、气道出血、痰痂形成情况,是否成功拔除气管插管,血氧饱和度及平均带管时间。结果研究组在痰液黏稠度(P=0.03)、刺激性咳嗽(P=0.04)、气道出血(P=0.01)、痰痂形成(P=0.02)方面,气道管理效果均明显优于对照组;研究组血氧饱和度明显高于对照组(P=0.03),平均带管时间明显低于对照组(P=0.01);两组拔管率差异无统计学意义(P=0.44)。结论 T管加温湿化在机械通气患者试脱机阶段可有效稀释痰液,减少气道并发症,增加氧疗效果,取得很好的气道管理效果。
Objective To evaluation the airway management effect of mechanically ventilation patients at offline stage with the implementation of T tube warming humidification. Methods Sixty critically ill patients using mechanical ventilation and meeting the offline indications after treatment were randomly assigned to receive humidification with T tube ( control group,30 cases) or warming humidification with T tube ( study group,30 cases) . The control group used T tube connected with the adjustable infusion device to control the humidification fluid velocity,whereas the study group used a heater placed at adjustable infusion set 10 cm from T tube to maintain the heat and humidity. Patients were observed for sputum viscosity,irritating cough,airway bleeding, phlegm scab formation,success rate of extubation,oxygen saturation,and average time with endotracheal intubation. Results Compared with the control group,the study group had significantly decreased sputum viscosity ( P =0. 03) ,irritating cough ( P =0. 04) ,airway bleeding ( P =0. 01) ,phlegm scab formation ( P =0. 02) ,increased oxygen saturation ( P = 0. 03) ,and shorter average time with endotracheal intubation ( P = 0. 01) . The success rate of extubation between two groups had no significant difference ( P = 0. 44) . Conclusion T tube warming humidification in mechanically ventilated patients at offline stage can achieve good airway management by reducing airway irritation,decreasing sputum production,and enhancing the effectiveness of oxygen therapy.

关键词(KeyWords): 加温湿化吸氧技术;试脱机患者;气道管理效果
atomized humidification oxygen inhalation technique; offline patients; airway management effect

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作者(Author): 华小雪;周文华;高健;绳宇;孙红;
HUA Xiao-xue 1 ,ZHOU Wen-hua 1 ,GAO Jian 1 ,SHENG Yu 2 ,SUN Hong 3 1 Department of Emergency, 3 Department of Nursing,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2 School of Nursing,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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