ICU长期机械通气患者气道湿化效果探讨

Effects of humidification in long-term mechanical ventilation patients in intensive care unit

目的探讨ICU长期机械通气患者的最佳气道湿化方法。方法随机选取入ICU行机械通气大于48 h、既往无肺部疾病、年龄大于18岁的脑卒中患者,分为A、B两组各10例患者。A组为试验组,采用新型MR850湿化器;B组为对照组,采用传统MR410湿化器。室温控制在20℃～24℃。通气模式均为同步间歇指令通气(SIMV),吸入氧浓度(FiO2)≤45%,呼气末正压(PEEP)≤7 cmH2O。观察两组患者的湿化效果、气管导管不同点吸入气体的温度、呼吸机相关性肺炎(VAP)的发生率、气道峰压等方面的差异。结果两组患者在年龄、体温、分钟通气量等方面差异均无统计学意义(P>0.05)。试验组在痰液黏稠度、气道阻力、肺部感染情况等方面均比对照组发生率低(P<0.05)。与对照组相比,试验组在机械通气48 h后,吸入气道内的气体温度接近人体的体温,湿化效果满意,并发症少。结论采用MR850湿化器使吸入气体的温湿度接近人体的生理水平,接近最佳湿化效果。

Objective To explore the optimal humidification method during long-term mechanical ventilation.Methods Twenty cases were collected randomly from the patients with non-pulmonary reasons and were divided into two groups（n=10）： experimental group（group A）,control group（group B）.MR850 humidifier was used in group A,MR410 was used in group B.To be eligible for enrollment,patients had to be ≥ 18 years old and orally intubated and mechanically ventilated for at least 48 h.All patients were received intermittent positive pressure ventilation;inspired oxygen gas concentrations were ≤ 45% with positive end expiratory pressure ≤ 7 cmH2O.The temperature of ICU was controlled at 20 ℃～24 ℃.Indicators of the two groups such as： humidification effect,the temperature at different points of endotracheal tube,the incidence of ventilator-associated pneumonia and peak airway pressure were observed.Results There was no difference in the body＇s temperature,height,and minute ventilation between two groups.Compared with the control group,the incidence of the ventilator-associated pneumonia and airway resistance were lower in experimental group and after 48 h of mechanical ventilation,the inspired gas of experimental group was close to the body＇s temperature,with better effective humidity and few complications.Conclusion MR850 humidifier can make the inspired gas temperature and humidity close to the physiological functions and reach to the optimal humidification.