人工鼻替代加热湿化系统在呼吸机治疗中的应用

目的 研究人工鼻(HME)替代加热湿化装置在呼吸机治疗中的可行性.方法 将近3年入住ICU的应用呼吸机治疗2 d以上的患者266例,应用阶段性病例分组对照的方法 分为实验组(人工鼻组)141例和对照组(加热湿化器组)125例,在湿化效果、应用人工气道时间、应用呼吸机时间、住ICU的时间、VAP发生率、病死率等方面进行对比研究和分析.结果实验组患者痰液湿化效果好的病例多于对照组,湿化不足、湿化过度及气道痉挛的病例均少于对照组.实验组在应用呼吸机时间和住ICU的时间上均少于对照组.实验组VAP发生率低于对照组.应用人工气道时间2组病例比较无差异;病死率2组病例比较无差异;实验组无湿化意外出现,对照组发生气道烫伤1例,发生呛水11例.结论 在呼吸机治疗中HME可以完全替代加热湿化系统在临床推广应用,但在应用时要注意观察患者病情变化、监测湿化效果和保持人工鼻通畅.

Research in the replacement of heated humidifiers with heat moisture exchangers during mechanical ventilation

Objective To study the feasibility of using heat and moisture exchangers (HME)as an alternative to heated humidifiers (HH) in patients undergoing mechanical ventilation. Methods 266 pa-tients with mechanical ventilation admitted to our ICU over the recent 3 years were allocated to the experi-mental group (humidification with a heat and moisture exchanger) and the control group (with heated hu-midifier), and the effect of humidification, the reserved time of artificial airway, the time on mechanical yen-tilation, the time of stay in ICU, the ineidenee of ventilator-associated pneumonia (VAP) and the mor-tality rate were comparatively studied and analyzed. Results Significant differences were found between the experimental and the control group in effect of humidification, insufficiency of humidification or excessive hu-midification, airway spasm and time on mechanical ventilation and time of stay in ICU. The incidence of VAP in the control group was significantly higher than that in the experimental group. There were no significant dif-ference between the two groups in the reserved time of artificial airway and the mortality rate. There were no accident of humidification occurred in the experimental group while there were one case complicated with air-way burn and 11 eases complicated with choking with water in the control group. Conclusions We conclude that HH can be replaced by HME on mechanical ventilation while disease evolution and effect of humidification should be monitored closely and keep HME unobstructed.