ALI/ARDS患者无创正压通气不同湿化方式选择的研究

A Comparative Study on Different Humidification Systems for NIPPV in ALI/ARDS Patients

目的探讨对ALI/ARDS患者进行无创正压通气时不同湿化加热方式的效果。方法45例ALI/ARDS患者随机分为三组进行无创正压通气,分别采用三种不同的湿化加热方式。每组15例。A组:使用370湿化罐湿化,不加热;B组:使用370湿化罐湿化,同时使用湿化罐加热器MR410加热;C组:使用MR850湿化器湿化和加热,并以RT308管道加热装置加热输气管道。比较各组湿化前后的输入气温度、绝对湿度、痰液黏稠度和患者舒适度。采用气道分泌物评分(AWSS)评价痰液黏稠度。结果湿化后B组和C组气体温度、气体绝对湿度和AWSS评分均显著增高(P均<0.001),B组由湿化前的(23.9±1.0)℃、(9.8±1.3)mg/L和(2.0±0.7)分上升至湿化后的(30.3±1.7)℃、(31.0±2.3)mg/L和(3.0±0.9)分;C组由湿化前的(23.8±1.0)℃、(9.8±1.5)mg/L和(2.1±0.7)分上升至湿化后的(34.0±1.1)℃、(43.8±2.5)mg/L和(3.5±1.0)分;其中C组气体温度和绝对湿度显著大于B组(P<0.001)。A组湿化后仅气体绝对湿度显著升高[(11.9±0.9)mg/L比(9.9±1.6)mg/L,P<0.001)]。C组舒适度评分显著高于A组和B组[(8.0±1.7)分比(5.0±1.2)分和(3.0±0.4)分,P<0.001)]。A组有7例因舒适度差转为C组湿化方案,其中4例能继续无创通气,2例最终避免了有创通气。B组有3例因管道冷凝水产生转为C组湿化方案,3例患者均能继续无创通气,1例患者最终避免了有创通气。结论对ALI/ARDS患者进行无创通气时,湿化同时对湿化罐和输气管道进行加热,相比单纯湿化或湿化罐加热方法更能提高输入气体的温度、患者舒适度和绝对湿度,并可降低痰液黏稠度。

Objective To explore the effects of different humidification and heating strategies during non-invasive positive pressure ventilation（NIPPV） in patients with ALI/ARDS. Methods A total of 45 patients with ALI/ARDS were randomly divided into three groups to receive NIPPV with different humidification and heating strategies, ie. Group A （humidification with a 370 Humidifier without heating）, group B （humidification with a 370 Humidifier along with a MR410 Heater）, and group C （humidification and heating with a MR850 Humidifier, and a RT308 circuit heater）. The changes of air temperature, absolute humidity, relative humidity, sputum thickness and patient comfort were compared between the three groups. Sputum thickness was evaluated with AWSS scoring system. Results After humidification and heating, the air temperature, absolute humidity and AWSS score improved significantly in group B [ elevated from （23.9 ± 1.0） ℃, （ 9. 8 ± 1.3 ） mg/L and 2. 0±0. 7 respectively to （ 30. 3 ± 1.7 ） ℃, （ 31.0 ± 2. 3 ） mg/L and （3.0 ±0. 9） respectively, P 〈0. 001 ] and group C [ elevated from （23.8 ± 1.0）, （9.8 ± 1.5） mg/L and （2. 1 ± 0.7 ） respectively to （ 34. 0 ± 1.1 ） ℃, （ 43.8 ± 2. 5 ） mg/L and 3.5 ± 1.0 respectively, P 〈 0. 001 ]. Air temperature and absolute humidity were significantly higher in group C than those in group B （P 〈 0. 001 ）. Of all the parameters, only absolute humidity showed a significant improvment in group A [ elevated from （ 9.9 ±1.6 ） mg/L to （ 11.9 ± 0. 9 ） mg/L, P 〈 0. 001 ]. The degree of comfort in group C was significantly higher than that in group A and B [ 8.0 ± 1.7 vs 5.0 ± 1.2 and 3.0 ± 0. 4, respectively, P 〈 0. 001 ]. In group A seven patients were switched to group C because of discomfort, four accepted NIPPV continuously, and two avoided invasive mechanical ventilation eventually. In group B three patients were switched to group C because of intolerance of too much condensed water in the breathing circuit, all of them accepted NIPPV continuously, and one avoided invasive mechanical ventilation eventually. Conclusions Compared with mere humidification or humidification with heating humidifier, humidification with heating humidifier and circuit heating during NIPPV can improve the absolute humidity, air temperature and patient comfort, meanwhile decreasing the sputum thickness of patients with ALI/ARDS.