射流压力雾化泵临床雾化效果对比研究

doi:10.12114/j.issn.1007-9572.2019.00.798

摘要/Abstract

摘要： 背景　雾化吸入疗法是呼吸系统疾病的重要治疗方法，临床常见雾化吸入装置有射流压力雾化泵、超声雾化泵以及振动筛孔雾化泵，其中射流压力雾化泵使用率最高。射流压力雾化泵品牌较多，缺乏统一使用标准，国内外报道较少。目的　比较不同射流压力雾化泵及其喷雾器雾化时间和雾化后残余药量的差异。方法　选取呼吸与危重病学科示教室为实验室，于2019-03-15至2019-03-21进行试验。本研究在相同的密闭环境进行，所有射流压力雾化泵及喷雾器经检测符合各自品牌说明书标准，每组雾化10次。分别选用三种射流压力雾化泵a、b、c及其对应的喷雾器a1、b1、c1进行配对组合，分为aa1组、bb1组、cc1组、ab1组、ac1组、ba1组、bc1组、ca1组、cb1组。比较九组10 ml 0.9%氯化钠溶液的雾化时间、雾化后残余药量、平均雾化率。比较aa1、bb1、cc1组4 ml 0.9%氯化钠溶液的雾化时间、雾化后残余药量、平均雾化率。比较aa1、bb1、cc1组10 ml和4 ml 0.9%氯化钠溶液的雾化后残余药量。结果　ab1组10 ml 0.9%氯化钠溶液雾化时间长于aa1、ac1、ba1、bb1、bc1、ca1、cb1、cc1组（P<0.05）；aa1组10 ml 0.9%氯化钠溶液雾化后残余药量多于ab1、ac1、ba1、bb1、bc1、ca1、cb1、cc1组（P<0.05）；bb1组10 ml 0.9%氯化钠溶液平均雾化率高于aa1、ab1、ac1、ba1、bc1、ca1、cb1、cc1组（P<0.05）。aa1组4 ml 0.9%氯化钠溶液雾化时间长于bb1组和cc1组（P<0.05）。aa1组4 ml 0.9%氯化钠溶液雾化后残余药量多于bb1组和cc1组（P<0.05）。bb1组4 ml 0.9%氯化钠溶液平均雾化率高于aa1组和cc1组（P<0.05）。bb1组4 ml 0.9%氯化钠溶液雾化后残余药量少于10 ml 0.9%氯化钠溶液雾化后残余药量（P<0.05）。结论　不同的射流压力雾化泵和喷雾器雾化时间、雾化后残余药量差异较大，临床上为患者雾化治疗应选择合适的射流压力雾化泵及其配套喷雾器；合理安排每次雾化量和雾化次数，以获得最大治疗效果；各厂家应在说明书中标注射流压力雾化泵和喷雾器的输出压力、输出流量、雾化后残余药量及雾化率等参数，便于临床选择。

关键词: 呼吸系统；肺疾病, 慢性阻塞性；哮喘；雾化器和汽化器；疗效比较研究

Abstract: Background　Atomization inhalation therapy is an important treatment for diseases of respiratory system.The common atomization inhalation devices include jet atomization pump，ultrasonic atomization pump and vibrating mesh technology，among which jet atomization pump has the highest utilization rate.There are many brands of jet atomization pumps，but there is a lack of unified use standards，and there are few reports on them.Objective　To compare the atomization time and residual volume after atomization of different jet-pressure atomization pumps.Methods　This study was conducted from March 15 to March 21，2019 in the classroom of Department of Respiratory and Critical Care.All atomization pumps and atomizers were tested under the same confined conditions in accordance with the standards of their respective brand specifications，and each group atomized 10 times.The three pressure jet atomization pumps of a，b and c and their corresponding atomizers of a1，b1，and c1 were paired，which were divided into aa1，bbl，cc1，ab1，ac1，ba1，bc1，ca1 and cb1 groups.The atomization time, residual dosage and average atomization rate of 10 ml 0.9% sodium chloride solution. The atomization time, residual dosage and average atomization rate of 4 ml 0.9% sodium chloride solution in aa1, bb1 and cc1 groups were compared. The residual dosage of 10 ml and 4 ml 0.9% sodium chloride solution in aa1, bb1 and cc1 groups were compared.Results　The atomization time of 10 ml 0.9% sodium chloride solution in ab1 group was longer than that of groups of aa1，ac1，ba1，bb1，bc1，ca1，cb1，cc1（P<0.05）.The volume after atomization of 10 ml 0.9% sodium chloride solution in aa1 group was more than that of groups of ab1，ac1，ba1，bb1，bc1，ca1 ，cb1 and cc1（P<0.05）.The average atomization rate of 10 ml 0.9% sodium chloride solution in bb1 group was higher than that of groups aa1，ab1，ac1，ba1，bc1，ca1，cb1，cc1（P<0.05）.The atomization time of 4 ml 0.9% sodium chloride solution in aa1 group was longer than that in bb1 group and cc1 group（P<0.05）.The residual volume after atomization of 4 ml 0.9% sodium chloride solution in aa1 group was more than that in bb1 group and cc1 group（P<0.05）.The average atomization rate of 4 ml 0.9% sodium chloride solution in bb1 group was higher than that in aa1 group and cc1 group（P<0.05）.The residual volume after atomization of 4 ml 0.9% sodium chloride solution was less than that of 10 ml 0.9% sodium chloride solution after atomization in bb1 group（P<0.05）.Conclusion　There are great differences in atomization time and residual volume after atomization between different atomization pumps and atomizers.Suitable atomization pump and its supporting atomizer should be selected for atomization treatment of patients.Reasonable arrangement of each atomization amount and atomization times is necessary to obtain the maximum therapeutic effect.Each manufacturer should mark the output pressure，output flow rate，residual volume after atomization，atomization rate and other parameters of atomizing pumps and atomizers in specifications so as to facilitate clinical selection.

Key words: Respiratory system；Pulmonary disease, chronic obstructive；Asthma；Nebulizers and vaporizers；Comparative effectiveness research

王欢英,许望梅,吴英,等. 射流压力雾化泵临床雾化效果对比研究[J]. 中国全科医学, 2020, 23(12): 1508-1512. DOI: 10.12114/j.issn.1007-9572.2019.00.798.
WANG Huanying,XU Wangmei,WU Ying, et al. Comparative Study of Clinical Atomization Effect of Pressure Jet Atomization Pumps　[J]. Chinese General Practice, 2020, 23(12): 1508-1512. DOI: 10.12114/j.issn.1007-9572.2019.00.798.

参考文献

［1］IBRAHIM M，VERMA R，GARCIA-CONTRERAS L.Inhalation drug delivery devices：technology update［J］．Med Devices（Auckl），2015，8：131-139．DOI：10.2147/MDER.S48888.
［2］李恒涛，王根在，田铭霞，等．社区卫生服务中心雾化室建设标准（上海市浦东新区、奉贤区专家共识）［J］．中国全科医学，2018，21（34）：4174-4177．DOI：10.12114/j.issn.1007-9572.2018.00.219.
LI H T，WANG G Z，TIAN M X，et al．Standards for the construction of aerosol therapy room in community heath centers:a consensus statement developed by experts from Shanghai's Pudong New Area and Fengxian District ［J］．Chinese General Pratice，2018，21（34）：4174-4177．DOI：10.12114/j.issn.1007-9572.2018.00.219.
［3］李凡，盛春风，高臻，等．呼吸门诊综合诊疗中心在慢性呼吸系统疾病分级诊疗中的作用［J］．中国全科医学，2018，21（36）：4493-4497．DOI：10.12114/j.issn.1007-9572.2018.00.136.
LI F，SHENG C F，GAO Z，et al．Role of respiratory out-patient clinic comprehensive diagnosis and treatment center in hierarchical diagnosis and treatment of chronic respiratory diseases［J］．Chinese General Practice，2018，21（36）：4493-4497．DOI：10.12114/j.issn.1007-9572.2018.00.136.
［4］申昆玲，李云珠，李昌崇，等．糖皮质激素雾化吸入疗法在儿科应用的专家共识（2018年修订版）［J］．临床儿科杂志，2018，36（2）：95-107．DOI：10.3969/j.issn.1000-3606.2018.02.004.
SHEN K L，LI Y Z，LI C C，et al．Expert consensus on the application of aerosol inhalation therapy of glucocorticoid in pediatrics（revised edition 2018）［J］．Journal of Clinical Pediatrics，2018，36（2）：95-107．DOI：10.3969/j.issn.1000-3606.2018.02.004.
［5］齐征.培养中国呼吸与危重症医学的“种子选手”［N］．中国青年报，2017-03-30（6）.
［6］张晓东.科室规范化建设引领呼吸学科同质化发展［N］．健康报，2018-04-17.
［7］李海玲，李凡.GOLD 2017更新要点解读及其对中国慢性阻塞性肺疾病分级诊疗的启示［J］．中国全科医学，2017，20（18）：2171-2175.DOI：10.3969/j.issn.1007-9572.2017.18.001.
LI H L，LI F.Implications of updated points of GOLD 2017 for the hierarchical diagnosis and treatment of COPD in China［J］．Chinese General Practice，2017，20（18）：2171-2175.DOI：10.3969/j.issn.1007-9572.2017.18.001.
［8］中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识［J］．中华医学杂志，2016，96（34）：2696-2708．DOI：10.3760/cma.j.issn.0376-2491.2016.34.003.
［9］中国医师协会急诊医师分会，中国人民解放军急救医学专业委员会，北京急诊医学学会，等．雾化吸入疗法急诊临床应用专家共识（2018）［J］．中国急救医学，2018，38（7）：565-574．DOI：10.3969/j.issn.1002-1949.2018.07.002.
Emergency Physicians Branch of Chinese Medical Doctor Association，Emergency Medicine Professional Committee of Chinese People's Liberation Army，Beijing Emergency Medicine Society，et al.Expert consensus on emergency clinical application of nebulizing inhalation therapy（2018）［J］．China Emergency Medicine，2018，38（7） :565-574．DOI：10.3969/j.issn.1002-1949.2018.07.002.
［10］中国物联网辅助雾化吸入治疗专家组.物联网辅助雾化吸入治疗中国专家共识［J］．国际呼吸杂志，2017，37（10）：721-728．DOI：10.3760/cma.j.issn.1673-436X.2017.10.001.
Expert Group of Iot Assisted Atomization Inhalation Therapy in China.Chinese expert consensus on iot assisted atomization inhalation therapy ［J］．International Journal of Breathing，2017，37（10）：721-728．DOI：10.3760/cma.j.issn.1673-436X.2017.10.001.
［11］中华医学会临床药学分会《雾化吸入疗法合理用药专家共识》编写组.雾化吸入疗法合理用药专家共识（2019年版）［J］．医药导报，2019，38（2）：135-146．DOI：10.3870/j.issn.1004-0781.2019.02.001.
Journal of Clinical Pharmacy，Chinese Medical Association.Expert consensus on rational drug use for atomized inhalation therapy（2019 edition）［J］．Herald of Medicine，2019，38（2）：135-146．DOI：10.3870/j.issn.1004-0781.2019.02.001.
［12］刘素彦，原志芳，刘芳.肺部疾病患者空气压缩雾化吸入疗法局部发生不良反应的原因及对策研究［J］．中华现代护理杂志，2017，23（10）：1349-1352．DOI：10.3760/cma.j.issn.1674-2907.2017.10.004.
LIU S Y，YUAN Z F，LIU F.Local adverse effect of compressed-air aerosol inhalation for patients with pulmonary diseases and countermeasures［J］．Chinese Journal of Modern Nursing，2017，23（10）：1349-1352．DOI：10.3760/cma.j.issn.1674-2907.2017.10.004.
［13］吴碧君，胡旭君.压缩式雾化器检测分析［J］．中国医疗器械信息，2018，24（16）：15-16，23．DOI：10.15971/j.cnki.cmdi.2018.16.007.
WU B J，HU X J.Detection and analysis of compressed atomizer［J］．China Med Device Inf，2018，24（16）：15-16，23．DOI：10.15971/j.cnki.cmdi.2018.16.007.