潘秋燕 苏弦

摘要：目的：探究气管切开患者应用加温湿化吸氧法对呼吸道阻力、肺部感染情况的影响。方法：选取2017年2月-2019年10月期间我院神经外科和神经内科患者136例，依据随机数字表法划分为两组，研究组与对照组，每组68例作为研究对象。对照组采用氧气雾化方式，研究组则采用加温湿化吸氧法，观察两组气道湿化效果、痰液粘稠度、肺部感染及呼吸道阻力情况。结果：湿化第1d及≥7d：研究组痰液粘稠Ⅱ度比例高于对照组（P<0.05），研究组痰液粘稠度Ⅰ及Ⅲ度比例低于对照组（P<0.05）;研究组的湿化满意度高于对照组（P<0.05）;研究组肺部感染率及呼吸道阻力增加率低于对照组（P<0.05）。结论：气管切开患者采用加温湿化吸氧法，不仅能显著降低痰液粘稠度，且气道湿化效果显著，还能避免肺部感染，降低呼吸道阻力，值得在临床上推广。

关键词：气管切开患者;加温湿化吸氧法;呼吸道阻力;肺部感染

【中图分类号】R714.2   【文献标识码】A    【文章编号】2107-2306（2020）02-037-02

Effects of warm humidification and oxygen inhalation on respiratory resistance and pulmonary infection in patients with tracheotomy

[Abstract] Objective： To explore the effect of warm humidification on respiratory resistance and pulmonary infection in patients with tracheotomy. Methods： 136 cases of Neurosurgery and neurology patients in our hospital from February 2017 to October 2019 were selected and divided into two groups according to the random number table method. The study group and the control group were 68 cases in each group. The control group was treated with oxygen atomization， while the study group was treated with warm humidification and oxygen inhalation. Results： on the 1st and 7th day of humidification， the proportion of sputum viscosity II in the study group was higher than that in the control group （P < 0.05）， and the proportion of sputum viscosity I and III in the study group was lower than that in the control group （P < 0.05）; the satisfaction degree of humidification in the study group was higher than that in the control group （P < 0.05）; the rate of pulmonary infection and increase of respiratory resistance in the study group was lower than that in the control group （P < 0.05）. Conclusion： the method of warming and humidifying oxygen inhalation can not only reduce the viscosity of sputum， but also the effect of airway humidifying， avoid lung infection and reduce the resistance of respiratory tract.

[Key words] tracheotomy patients; warming and humidifying oxygen inhalation; respiratory resistance; pulmonary infection

神經系统患者行气管切开是抢救危重症患者的常用方式。人体正常的上呼吸道吸入气体时具备过滤、加温、湿化及清洁的功效，使气体进入肺泡后温度可与体温近似，进而被其中水蒸气饱和。而患者气管切开后，其上呼吸道的湿化加温功能障碍，导致气道中纤毛活动性减弱或丧失，致使气道黏膜干燥异常，其中的分泌物呈现干结状态，继而导致患者排痰不畅增加形成痰痂的风险，干结严重者甚至会诱发肺不张、阻塞性肺炎等并发症^[1-2]。气管切开患者如若湿化过度则会增加排痰次数及气道中痰液粘稠度，严重者会出现窒息或缺氧现象。因此部分临床专家认为在气管切开患者中采取优质的气道湿化加温干预措施能确保患者呼吸畅通，降低痰痂形成几率，避免肺部感染等并发症产生^[3]。因此本研究主要就气管切开患者应用加温湿化吸氧法对呼吸窘迫综合征、肺部感染、气道痰液湿化情况的影响详加探究，现汇报如下。……