新型高流量湿化氧疗系统对气管切开非机械通气患儿下呼吸道感染的预防作用

The preventive effect of the new high-flow humidification oxygen therapy system on lower respiratory tract infection in tracheostomized non-ventilatory pediatric patients

目的探讨新型高流量湿化氧疗系统对气管切开非机械通气患儿预防下呼吸道感染的应用效果。方法纳入儿童重症监护病房(PICU)气管切开非机械通气患儿56例,所有患儿在气管切开前均无肺部感染。采用前瞻性随机对照法分为对照组和实验组各28例。实验组采用新型高流量湿化氧疗系统对氧气进行加温湿化,对照组采用传统的人工气道湿化法。观察两组气管切开后痰液粘稠度,痰痂形成的例数及肺部感染率,氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SpO2)。结果实验组痰液粘稠度Ⅰ°、Ⅲ°例数及痰痂形成例数、吸痰次数均少于对照组,最初两周内实验组肺部感染率多重耐药菌感染率低于对照组,且感染时间迟,(P均<0.05)。比较两组氧疗后24 h及48 h PaO2、PaCO2、SpO2,差异均有统计学意义(P均<0.01)。结论使用新型高流量湿化氧疗系统减少了下呼吸道感染率,提高了患儿氧疗舒适度和疗效。

Objective To investigate the preventive effect of the new high-flow humidification oxygen therapy system on lower respiratory tract infection in tracheostomized non-ventilatory pediatric patients. Methods A total of 56 tracheostomized non-ventilatory patients in pediatric intensive care unit, who were excluded from lung infection prior to the tracheotomy, were included in the study. They were randomly divided into the control and experimental groups, 28 cases in each group. The patients in the experimental group received heated and humidified high-flow oxygen therapy with the new system, while the patients in the control group were managed with traditional artificial airway humidification. Sputum viscosity, the number of samples with sputum scab formation, the incidence of pulmonary infection and the levels of PaO2, PaCO2, SpO2 were observed in both groups. Results The number of samples with sputum viscosity Ⅰ°、Ⅲ°and with sputum scab formation, the times of sputum suction were less in the experimental group than those in the control group （all P〈 0.05）. Compared with the control group, the rate of the lungs infection and the multi-resistance bacterial infection in the experimental group was significantly lower during the first two weeks, with the infection＇s time-delay （all P 〈 0.05）. There were statistical significances in levels of PaO2, PaCO2, SpO2 within 24 h, 48 h after oxygen therapy between the two groups （all P〈 0.01）. Conclusion The new type of high-flow humidification oxygen therapy system can reduce the rate of respiratory tract infection, improve comfort and efficacy of the oxygen therapy in tracheostomized non-ventilatory pediatric patients.