气管切开病人气道湿化调整方案的评价研究

Study on evaluation of adjustment programs for airway humidification of patients accepted tracheotomy

[目的]探讨气管切开术后病人痰液黏稠度不同所需的气道湿化量。[方法]随机选取气管切开术后病人180例次,根据痰液黏稠度不同分为Ⅰ度、Ⅱ度、Ⅲ度3组,每组分为实验组和对照组。第一组中实验组36 h内气道湿化量为6 mL/h,36 h^48 h之间逐渐过渡为12mL/h;第二组中实验组气道湿化量为12 mL/h;第三组中实验组36 h内气道湿化量为16 mL/h,36 h^48 h之间逐渐过渡为12 mL/h;3组中对照组均给予间歇气管内滴入,使用注射器每2 h向气管内滴入0.45%氯化钠溶液4 mL/h^6mL/h。72 h后对痰液黏稠度进行评估,并应用脉冲震荡肺功能仪检测肺功能,统计气道并发症发生情况。[结果]实验组气道湿化情况均优于对照组(P<0.05);实验组与对照组在弹性阻力(X5)、周边气道阻力(R5-R20)、共振频率(Fres)方面具有统计学意义(P<0.05);实验组刺激性咳嗽、黏膜出血、痰痂形成及肺炎发生率均明显低于对照组(P<0.05)。[结论]不同痰液黏稠度病人应给予不同的气道湿化调整方案,应用持续的气道内滴药的湿化方法,对气道刺激性小,能减少刺激性咳嗽、黏膜出血、痰痂形成及肺炎等并发症,并能维持较好的肺功能。

Objective：To probe into the required amount of airway humidification for patients after accepting tracheotomy with different sputum viscosity.Methods： A total of 180 patients after accepting tracheotomy were randomly divided into three groups（group Ⅰ,Ⅱ,Ⅲ） according to different sputum viscosity.Each group was divided into test group and control group further.The amount of airway humidification of patients in the test group of group I was to begin at 6 mL/h within the first 36 h and gradually increased to 12 mL/h within 36 h^48 h.The amount of airway humidification of patients in test group of group Ⅱ was at 12 mL/h.The amount of airway humidification of patients in test group of group Ⅲ was to begin at 16ml/h within the first 36h and then gradually decreased to 12 mL/h in 36 h^48 h.All control groups cases of group Ⅰ,Ⅱ,and Ⅲ were given intratracheal instillation of 0.45% NaCl solution 4 mL/h^6 mL/h intermittently every 2 h by using syringes.Sputum viscosities of all patients were evaluated and the lung function of them was detected with pulse shaking method 72 h later.Then the occurrences of airway complications of all cases were analyzed statistically.Results：The airway humidification of test group patients was better than that of control group cases（P0.05）.There were statistical significant differences between the two group cases in terms of the elastic resistance（X5）,the peripheral airway resistance（R5-R20） and the resonance frequency（Fres）（P0.05）.The occurrence of the irritating cough,mucosal bleeding,sputum scab formation and pneumonia of test group patients were obviously less than that of control group cases（P0.05）.Conclusion：Patients with different sputum viscosity should be given different adjustment regimen of airway humidification.To apply persistent intratracheal instillation humidification for patients after accepting tracheotomy could reduce the irritating cough,mucosal bleeding,sputum scab formation and pneumonia and maintain good lung function of patients.