摘要
目的：本研究依据分子热力学原理，气体温度与湿度、弥散速度均呈线性关系，即气体温度越高，气体的湿度越高，分子的弥散速度也越快，探讨使用接近人体鼻腔温度(30℃-35℃)的湿化液进行湿化氧疗对呼吸系统感染性疾病患者氧疗舒适度和氧疗效果的影响，寻求和探讨临床氧疗湿化液适宜的温度，为临床氧疗湿化液温度的设定提供参考依据。
内容和方法：本研究选取2006年9月至2007年2月天津医科大学总医院呼吸科住院患者84例。将符合要求的84例患有呼吸系统疾病且接受吸氧治疗的患者随机分成试验组和对照组，其中试验组42例，对照组42例。所有患者均在护理干预前填写吸氧情况调查问卷，进行基线测评(包括患者一般情况、病情、治疗方案、吸氧治疗情况等)。试验组和对照组患者均接受常规治疗和护理。对照组患者给予室温湿化氧疗，试验组患者使用新西兰Fisher & Paykel医疗保健有限公司生产的MR850加温湿化器，进行加温湿化氧疗，每日2次，每次2小时，连续干预三天。干预三天后，试验组和对照组患者填写吸氧情况调查问卷，进行第二次测评。
结果：(1)护理干预前患者填写吸氧情况调查问卷，进行基线测评，试验组和对照组在一般情况、病情、治疗方案、吸氧治疗情况方面的差异没有统计学意义(P＞0.05)，具有可比性。(2)护理干预三天后患者填写吸氧调查问卷，进行第二次测评，两组患者在氧气温度、湿度、鼻咽部感觉、咳嗽、咳痰难度、痰量、痰液性状方面的差异有统计学意义(P＜0.05)：两组患者在氧气气味，体温，脉搏，呼吸，血压方面的差异没有统计学意义(P＞0.05)。对呼吸系统感染性疾病患者来说，加温湿化氧疗较室温湿化氧疗更利于提高患者的氧疗舒适度，即在氧气温度、湿度、鼻咽部感觉、咳嗽、咳痰难度方面有明显改善作用；对患者的痰液性状和痰量也有所改善，但在氧气气味、流速、下呼吸道感觉、全身感觉及体温、脉搏、呼吸、血压方面未见差异。
结论：目前临床中使用的室温湿化氧疗的湿化液为病室室温(20℃～22℃)，使用此温度的湿化液进行湿化氧疗，吸入气温度远远低于人体鼻腔温度(30℃～35℃)。患者感觉吸入气温度较低且较干燥，患者感觉鼻咽部不适。加温湿化氧疗，使患者吸入的氧气温度在30℃～35℃，接近人体鼻腔温度，随氧气温度增高，氧气的湿度和弥散速度也相应提高，充分温化湿化的氧气流经呼吸道时，避免吸入气对呼吸道粘膜的刺激，患者感觉舒适，对患者咳嗽、咳痰等呼吸道症状有明显改善作用，有利于改善患者缺氧症状，提高氧疗效果。可见，适当提高吸入氧气的温度，一定程度上可提高呼吸系统疾病患者的氧疗舒适度和氧疗效果，利于患者疾病恢复，但是否能全面提高吸氧疗效，需要进一步研究。针对这一研究结果，应在临床中普及加温湿化氧疗，解决目前临床中出现的氧疗问题，提高患者氧疗依从性，提高氧疗效果。
Object: According to molecular heat principle, the humidity and activity of gas are linearrelation with the gas temperature, that is, the humidity and activity of gas go up with the raise ofthe gas temperature. The research is done in order to examine the effect of heated oxygen on thecomfortableness and treatment effect of patients with the disease of respiratory system whoaccept oxygen therapy, find the optimal temperature of oxygen therapy and provide referencebasis for oxygen therapy.
Methods: Selecting 84 patients in respiratory division of General Hospital of Tianjin MedicalUniversity. 84 eligible patients with the disease of respiratory system were randomly assigned toeither the intervention group (n=42) or the control group (n=42). All patients completedquestionnaires of oxygen therapy at baseline assessment. Patients in the intervention group andthe control group received routine nursing care and took analgesic medicine as prescribed.Patients in the intervention group were treated by heated and humidified oxygen individuallywho used the MR850 heated humidification tool of Fisher & Paykel medical care limitedcompany in New-Zealand, 2 hours twice a day for three days. And patients in the control groupwere treated by ambient humidified oxygen individually 2 hours twice a day for three days. Afterthat, all patients were similarly reassessed.
Results: (1) Before the intervention, all patients fill in the questionnaires. The comfortablenessand treatment effect of 42 patients in the intervention group were the same as those in the controlgroup at baseline assessment (P＞0.05), which is comparable. (2) When the two groups werereassessed after three days, there was statistical significance between the two groups in thefollowing aspects (P＜0.05): oxygen temperature, oxygen humidity, pharynx nasals' feeling, cough, expectoration difficulty, phlegm fluidity form and phlegm quantity. (3) There was nostatistical significance between the two groups in the aspects of oxygen smell, flow rate, feelingof lower respiratory tract, feeling of body, body temperature, arterial pulse, respiration and bloodpressure(P＞0.05). Heated oxygen therapy is more beneficial for comfortableness of patients withthe disease of respiratory system, which effect on oxygen temperature, humidity, pharynx nasals'feeling, cough, expectoration difficulty, phlegm fluidity form and phlegm quantity. But heatedoxygen therapy don't effect on oxygen smell, flow rate, feeling of lower respiratory tract, feelingof body, body temperature, arterial pulse, respiration and blood pressure.
Conclusion: The oxygen temperature is the same as ambient temperature (20℃～22℃) inoxygen therapy, which is lower than the temperature of nasal cavity (30℃～35℃). The patientsfeel that inhaled gas is dry and cold. Oxygen temperature is 30℃～35℃in heated oxygentherapy, which gets closer to the temperature of nasal cavity. The humidity and activity of gas goup with the raise of the gas temperature. In order to avoid stimulus, heated oxygen inhaled into respiratory tract makes the patients comfortable and improves the effect of oxygen therapy.Heated oxygen therapy could improve on the comfortableness and treatment effect of patientswith the disease of respiratory system who accept oxygen therapy. Further research is stillneeded to examine the effectiveness of heated oxygen therapy on gas analysis in blood. Heatedoxygen therapy would be used in clinical in the future in order to make the patients comfortableand improve the effect of oxygen therapy.
引文
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