气管切开机械通气患者人工鼻的应用效果及护理

目的探讨人工鼻（heal and moisture exchanger,HME）在气管切开机械通气患者中的应用效果及其护理对策。方法将86例行气管切开机械通气的患者随机分成两组,对照组（40例）应用呼吸机上的加温湿化和雾化装置及湿化液的滴入进行呼吸道护理;实验组（46例）在对照组的基础上,在气管切开套管端与呼吸机连接端之间连接HEM,脱机后气管切开套管端连接HEM。比较两组患者呼吸道湿化和吸痰的次数、呼吸道阻塞和呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的发生率。结果两组患者每天行呼吸道湿化和吸痰次数的差异无统计学意义（P〉0.05）;实验组呼吸道阻塞和VAP的发生率低于对照组,差异均有统计学意义（均P〈0.05）。结论 HEM的加温、湿化功能在一定程度上弥补了人工呼吸道的缺陷,并可减少呼吸机内外环路的污染,有助于减少VAP的发生;但HEM的应用具有一定的局限性,临床使用过程中需严格掌握适应证及患者的使用效果和反应。

Application and Nursing of Heal and Moisture Exchanger in Tracheotomy Patients

Objective To study the airway heating,humidification and filtration of heal and moisture exchanger（HME）and the prevention effect of ventilator-associated pneumonia（VAP）.Methods Eight-six subjects were randomly divided into a control group（n=40）to apply the atomization temperature and humidity of airway humidification devices of the ventilator and instilling fluid in airway and an experimental group（n=46）to connect HME between the ventilator and the tracheostomy tube and to connect HME with tracheostomy tube after the withdrawal of ventilator based on the treatment of the control group.Comparisons were conducted in the frequencies of wet conditions and aspiration of sputum between the two groups.Results No significant difference was observed in the frequencies of wet conditions and aspiration of sputum between the two groups（P〉0.05）.The incidences of airway obstruction and VAP in experimental group were less than those in the control group and the difference was statistically significant（P〈0.05）.Conclusion The heating and humidification function of HME can compensate for the shortcomings of artificial airway,reduce the pollution of outer ring road and help reduce the incidence of VAP.Given the limitations of HME,the clinical application should adhere to the indications and treatment effects of the patients.