刘　芳，许亚红，张睦毅，龚立超，杨倩倩，阮　征



重型脑损伤并机械通气病人加温加湿器水位控制的临床研究

刘芳，许亚红，张睦毅，龚立超，杨倩倩，阮征

摘要：[目的]探讨影响重型脑损伤并机械通气病人加温加湿器内水位变化的相关因素，建立水位变化回归方程，为临床进行呼吸机加温加湿器持续注水速度的设置提供依据。[方法]自制加温加湿器水量控制观察表，针对神经科重型脑损伤机械通气病人进行156例次的资料收集，4 h记录观察1次，应用Spearman相关分析筛选影响因素，并通过SPSS19.0统计获得影响水位变化多元线性回归方程。[结果]重型脑损伤机械通气病人的日耗水量为1 166.40 mL±329.04 mL，加温加湿器的水位变化与湿化罐注水输液器的滴注速度、病室温度、气道温度相关，湿化罐水位变化值(Y)的多元回归方程为Y=0.992+0.052×(小壶滴速)-0.097×(气道温度)+0.057×(病室温度)与Y=1.586+0.057×(小壶滴速)-0.077×(气道温度)两个线性回归方程。[结论]根据回归方程Y=1.586+0.057×(小壶滴速)-0.077×(气道温度)来进行临床实施与验证，这样不仅减少每班护士持续向湿化罐内注水的频次，也避免了医护人员在急救与繁忙时对注水的忽略，确保了重型脑损伤并机械通气病人应用呼吸机的安全性。

关键词：脑损伤；机械通气；加温加湿器；水位控制；气道湿化；注水速度；气道温度

Clinical study on water level control of heated humidifier in severe brain injury patients with mechanical ventilation

Liu Fang,Xu Yahong,Zhang Muyi,et al

(Xuanwu Hospital of Capital Medical University,Beijing 100053 China)

Abstractobjective:In order to investigate the influencing factors of water level control of heated humidifier on severe brain injury patients with mechanical ventilation，establish water level change regression equation,provide basis for clinical ventilator heated humidifier continuous water injection rate settings.Methods:It made a heated humidifier water control observation table.Data was collected in 156 cases of severe brain injury patients with mechanical ventilation,to record and observe once 4 h,the influencing factors were screened by Spearman correlation analysis，and the multiple linear regression equation of water level change was obtained by SPSS19.0 statistics.Results:The water consumption of severe brain injury patients with mechanical ventilation was 1166.40 mL±329.04 mL.The variation of humidifier heating water level was related to humidification tank water infusion drip injection speed,ward temperature,airway temperature.The multiple regression equation of humidification tank water level variation value of multiple regression equation(Y)=0.992+0.052×(small pot drop speed)-0.097×(airway temperature)+0.057×(ward temperature) andY=1.586+0.057×(small pot drop speed)-0.077×(airway temperature).Conclusion:According to the regression equationY=1.586+0.057×(small pot drop speed)-0.077×(airway temperature) for clinical implementation and verification.It not only reduced the frequency of per shift nurses continuing to water injection the into water tank,but also to avoid the medical staff ignoring water injection in emergency and busy time,ensure that the safety of severe brain injury patients with mechanical ventilation.

Key wordsbrain injury；mechanical ventilation；heated humidifier;water level control；airway moist;water injection speed；airway temperature

重型脑损伤机械通气病人的气道湿化主要采用主动加温加湿装置(heated humidification，HH)来控制加热罐内气体温度和湿度[1]。机械通气病人应用加温加湿器时会造成湿化罐内水量消耗，若不及时注水将导致罐内液体耗干造成气道湿化不足，引起气道纤毛和黏液腺等破坏，导致黏膜纤毛清除功能受损、气道损伤、肺不张[2]。……