人工气道不同气道湿化量的临床疗效分析

Clinical analysis of various humidification dose in artificial airway

目的探讨不同湿化量的人工气道湿化方法的临床疗效。方法选择2006年5月~2008年9月60例建立人工气道的患者,其中男性31例,女性29例;年龄22～87岁。随机分为试验组和对照组,每组30例。试验组男性15例,女性15例,平均年龄67岁;对照组男性16例,女性14例,平均年龄70岁。实验组以0.9%氯化钠溶液50mL加入糜蛋白酶4000U,用微量注射泵以2mL/h持续泵入,辅以吸痰前气道内滴入10～15mL0.9%氯化钠溶液;日湿化液量200mL左右。对照组以0.9%氯化钠溶液50mL加入糜蛋白酶4000U,用微量注射泵以8~10mL/h持续泵入,日湿化液量200mL左右。同时与28例气管切开行雾化吸入的患者进行对比。结果试验组刺激性咳嗽、肺部感染发生率明显低于对照组;气道出血两组之间没有显著差别,但吸痰次数试验组明显少于对照组,与雾化吸入组疗效比较差异无统计学意义（P〈0.05）。结论采用0.9%氯化钠溶液50mL＋糜蛋白酶4000U,用微量注射泵以2mL/h泵入湿化气道,可防止肺内感染扩散、减少痰痂形成及刺激性咳嗽的发生,同时有效清理呼吸道内分泌物和痰液,与雾化吸入临床疗效相当。

Objective To investigate the clinical therapeutic effect of humidification methods on artificial airway with various humidification dose. Methods A total of 60 patients（male 31, female 29; aged 22 - 87 years） performed artificial airway from May 2006 to September 2008 were enrolled. The patients randomly divided into experiment group（male 15, female 15; mean age 67 years） and control group（male 16, female 14, mean age 70 years）, 30 cases in each group. In experiment group, 50 mL physiological saline with 4 000 U chymotrypsin was continuously injected 2 mL/h with microinjection pump, and 10 - 15 mL physiological saline was dropped in artificial airway before suction. In control group, 50 mL physiological saline with 4 000 U chymotrypsin was continuously injected 8 - 10 mL/h with microinjection pump and humidification fluid volume was about 200 mL/24 hours in each group, and compared with 28 cases of tracheotomy patients with atomization inhalation. Results The incidence of irritating cough and pulmonary infection in experiment group were significantly lower than control group. There was no difference about airway bleeding between 2 groups. The suction frequency in experiment group was significantly less than that in control group. Compared with the atomization inhalation group, there was no significant difference in clinical efficacy. Conclusion It is demonstrated that 50 mL physiological saline with 4 000 U chymotrypsin continuously injected 2 mL/h with microinjection pump are recommended for humidifying the artificial airway. This method can prevent the intrapulmonary infection, decrease the sputum scab and the frequency of irritating cough, and also clear respiratory secretions and sputum effectively. It is showed that there is no difference between experiment and oxygen atomization group in clinical effect.