ICU气管切开患者撤机后应用呼吸湿化治疗仪的临床疗效观察
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摘要
目的观察重症加强治疗病房气管切开患者撤机后应用呼吸湿化治疗仪的临床疗效。方法将气管切开患者分成观察组(AIRVO_2呼吸湿化治疗仪组)和对照组(呼吸机湿化装置联合气切面罩加温湿化给氧组),各50例。在常规治疗基础上,观察两组撤机后0、6、12、24、48、72 h血气指标(pH、PaO_2、PaCO_2、PaO_2/FiO_2)、临床症状指标(心率、呼吸频率、血氧饱和度)、呼吸浅快指数(RSBI)、痰液黏稠度、肺部感染率、脱机成功率及日均撤机费用等指标并进行比较。结果在常规治疗基础上,两组经不同方案治疗后各项指标均取得明显改善。相同时间点痰液黏稠度气道湿化效果观察组明显优于对照组,差异有统计学意义(P<0.05)。治疗后各时点两组的心率、呼吸频率、血氧饱和度等指标较治疗前均有明显改善,且治疗后两组间相比较差异有统计学意义(P<0.05)。两组患者上述血气指标经治疗后均取得明显改善,不同时间点PaO_2、PaCO_2改善情况两组相比差异有统计学意义(P<0.05)。治疗72 h后,观察组RSBI、肺部感染率均低于对照组,脱机成功率高于对照组,差异有统计学意义(P<0.05)。观察组患者平均每住院日撤机单项费用低于对照组,差异有统计学意义(P<0.05)。观察组再次出现低氧血症1例,对照组出现低氧血症9例,需重新进行机械通气。结论重症加强治疗病房气管切开患者撤机后应用呼吸湿化治疗仪能取得较好的治疗效果,具有良好的临床推广应用价值。
Objective To investigate the clinical efficacy of AIRVO_2 respiratory humidification apparatus in patients with tracheotomy after successful weaning from mechanical ventilation in intensive care unit(ICU).Methods One hundred subjects were randomly divided into a control group(treated with the tracheotomy mask joint oxygen inhalation by heating humidifier,n=50) and an observation group(treated with AIRVO_2 model,n=50) on the basis of conventional therapy.Blood gas indexes(pH,PaO_2,PaCO_2,PaO_2/FiO_2) and clinical data(heart rate,respiratory rate,SpO_2,sputum viscosity) were recorded at 0 h,6 h,12 h,24 h,48 h,72 h after weaning.Besides,the incidence of postoperative pulmonary infection,rapid shallow breathing index(RSBI),successful weaning rate from mechanical ventilation and daily cost of weaning between the two groups were compared at 72 h after weaning.Results After treatment,all observed data of the patients were obviously improved compared with those before treatment.The differences of humidification effects between the observation group and the control group at the same time point were statistically significant(P<0.05).The differences of heart rate,respiratory rate,and SpO_2 between the observation group and the control group at the same time point were statistically significant(P<0.05).The improvement of PaO_2 and PaCO_2 at the same time point were statistically different between the observation group and the control group(P<0.05).Seventy-two hours after weaning,the incidence of postoperative pulmonary infection and RSBI in the observation group were significantly lower than those in the control group(P<0.05),successful weaning rate from mechanical ventilation in the observation group was significantly higher than that in the control group(P<0.05),and the average daily cost of weaning from mechanical ventilation in the observation group was lower than that in the control group(P<0.05).Nine patients in the control group and 1 patient in the observation group needed secondary mechanical ventilation due to hypoxemia.Conclusion The therapy of AIRVO_2 respiratory humidification apparatus combined with conventional treatment may achieve satisfactory effect for patients of successful weaning from mechanical ventilation with tracheotomy,and it is worthy of promotion in clinical use.
Objective To investigate the clinical efficacy of AIRVO_2 respiratory humidification apparatus in patients with tracheotomy after successful weaning from mechanical ventilation in intensive care unit(ICU).Methods One hundred subjects were randomly divided into a control group(treated with the tracheotomy mask joint oxygen inhalation by heating humidifier,n=50) and an observation group(treated with AIRVO_2 model,n=50) on the basis of conventional therapy.Blood gas indexes(pH,PaO_2,PaCO_2,PaO_2/FiO_2) and clinical data(heart rate,respiratory rate,SpO_2,sputum viscosity) were recorded at 0 h,6 h,12 h,24 h,48 h,72 h after weaning.Besides,the incidence of postoperative pulmonary infection,rapid shallow breathing index(RSBI),successful weaning rate from mechanical ventilation and daily cost of weaning between the two groups were compared at 72 h after weaning.Results After treatment,all observed data of the patients were obviously improved compared with those before treatment.The differences of humidification effects between the observation group and the control group at the same time point were statistically significant(P<0.05).The differences of heart rate,respiratory rate,and SpO_2 between the observation group and the control group at the same time point were statistically significant(P<0.05).The improvement of PaO_2 and PaCO_2 at the same time point were statistically different between the observation group and the control group(P<0.05).Seventy-two hours after weaning,the incidence of postoperative pulmonary infection and RSBI in the observation group were significantly lower than those in the control group(P<0.05),successful weaning rate from mechanical ventilation in the observation group was significantly higher than that in the control group(P<0.05),and the average daily cost of weaning from mechanical ventilation in the observation group was lower than that in the control group(P<0.05).Nine patients in the control group and 1 patient in the observation group needed secondary mechanical ventilation due to hypoxemia.Conclusion The therapy of AIRVO_2 respiratory humidification apparatus combined with conventional treatment may achieve satisfactory effect for patients of successful weaning from mechanical ventilation with tracheotomy,and it is worthy of promotion in clinical use.
引文
1沈海芬,张海英.脑外伤患者气管切开后不同黏稠度痰液适宜吸痰负压的临床研究.中华护理杂志, 2009, 44(8):694-697.
2赖士群,伍雪艳,梁伟霞,等.吸入性损伤气管切开病人吸痰方法探讨.护理研究, 2010, 24(19):1721-1722.
3单亮.气管切开时机对危重患者临床预后影响的meta分析.济南:山东大学, 2013.
4陈元杰,孙琳,彭琳,等.高流量湿化氧对危重患者脱机后呼吸功能的保护作用.中国呼吸与危重监护杂志, 2018, 17(3):259-262.
5燕朋波,全金梅,李志静,等.三种不同气道湿化方法对建立人工气道脱机患者效果研究.中国呼吸与危重监护杂志, 2014, 13(5):480-483.
6白二灵.浅谈气管切开术后的护理体会.世界最新医学信息文摘, 2015, 15(19):152-153.
7Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients:a prospective pilot study. Intensive Care Med, 2011, 37(11):1780-1786.
8Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure:a prospective observational study. J Crit Care,2012, 27(3):324.
9Lenglet H, Sztrymf B, Leroy C, et al. Humidified high flow nasal oxygen in the emergency department:feasibility and interest.Respiratory Care, 2012, 57(11):1873-1878.
10蓝惠兰,邓旭萍,陈瀚熙,等.机械通气呼吸湿化器湿化研究进展.护理学杂志, 2013, 28(13):94-97.
11肖凌月.人工鼻和呼吸机湿化器用于经人工气道行机械辅助通气病人的临床研究.护理研究, 2010, 24(1):209-210.
12江方正,李雪,叶向红,等.持续加温湿化氧疗在气管切开患者脱机中的应用.中华护理杂志, 2011, 46(2):128-130.
13姜超美,白淑玲,王辰,等.人工气道后痰液黏稠度的判别方法及临床意义.中华护理杂志, 1994, 29(7):434.
14中华人民共和国卫生部.医院感染诊断标准(试行).中华医院感染杂志, 2001, 36(8):495.
15黄维明,谢春雷,李春霞,等.神经外科重症监护病房气管切开患者肺部感染的目标性监测和干预.中华现代护理杂志, 2011,17(32):3911-3913.
16郭润玲,郭爱芝,王颖,等. Venturi+MR50氧疗在气管插管患者拔管中的应用.护理研究, 2014, 7(7C):2636-2637.
17赵彦卓,魏琼.呼吸湿化治疗仪在气管插管患者脱机后的应用.临床误诊误治, 2016, 29(S1):100-101.
18 李威,吴迪迪,黄思语.机械通气患者脱机后应用IRVO2呼吸湿化治疗仪、Stellar100无创呼吸机疗效观察.新疆医学, 2017,47(5):492-494.
2赖士群,伍雪艳,梁伟霞,等.吸入性损伤气管切开病人吸痰方法探讨.护理研究, 2010, 24(19):1721-1722.
3单亮.气管切开时机对危重患者临床预后影响的meta分析.济南:山东大学, 2013.
4陈元杰,孙琳,彭琳,等.高流量湿化氧对危重患者脱机后呼吸功能的保护作用.中国呼吸与危重监护杂志, 2018, 17(3):259-262.
5燕朋波,全金梅,李志静,等.三种不同气道湿化方法对建立人工气道脱机患者效果研究.中国呼吸与危重监护杂志, 2014, 13(5):480-483.
6白二灵.浅谈气管切开术后的护理体会.世界最新医学信息文摘, 2015, 15(19):152-153.
7Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients:a prospective pilot study. Intensive Care Med, 2011, 37(11):1780-1786.
8Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure:a prospective observational study. J Crit Care,2012, 27(3):324.
9Lenglet H, Sztrymf B, Leroy C, et al. Humidified high flow nasal oxygen in the emergency department:feasibility and interest.Respiratory Care, 2012, 57(11):1873-1878.
10蓝惠兰,邓旭萍,陈瀚熙,等.机械通气呼吸湿化器湿化研究进展.护理学杂志, 2013, 28(13):94-97.
11肖凌月.人工鼻和呼吸机湿化器用于经人工气道行机械辅助通气病人的临床研究.护理研究, 2010, 24(1):209-210.
12江方正,李雪,叶向红,等.持续加温湿化氧疗在气管切开患者脱机中的应用.中华护理杂志, 2011, 46(2):128-130.
13姜超美,白淑玲,王辰,等.人工气道后痰液黏稠度的判别方法及临床意义.中华护理杂志, 1994, 29(7):434.
14中华人民共和国卫生部.医院感染诊断标准(试行).中华医院感染杂志, 2001, 36(8):495.
15黄维明,谢春雷,李春霞,等.神经外科重症监护病房气管切开患者肺部感染的目标性监测和干预.中华现代护理杂志, 2011,17(32):3911-3913.
16郭润玲,郭爱芝,王颖,等. Venturi+MR50氧疗在气管插管患者拔管中的应用.护理研究, 2014, 7(7C):2636-2637.
17赵彦卓,魏琼.呼吸湿化治疗仪在气管插管患者脱机后的应用.临床误诊误治, 2016, 29(S1):100-101.
18 李威,吴迪迪,黄思语.机械通气患者脱机后应用IRVO2呼吸湿化治疗仪、Stellar100无创呼吸机疗效观察.新疆医学, 2017,47(5):492-494.