Abstract: Objective　To investigate the application value of oxygenation atomization combined with high-frequency vibration sputum extraction in airway management after tracheotomy and its effect on lung function. Methods　The clinical data of 69 patients who underwent tracheotomy for various reasons in Guangzhou Xinhai Hospital and Guangdong First Invalides Hospital from August 2020 to August 2021 were retrospectively analyzed, including 41 males and 28 females, and they were 31-81 years old. They were randomly divided into an oxygen atomization combined with high frequency vibration expectoration drainage group (38 cases; experimental group) and a conventional sputum suction group (31 cases, control group). According to airway stranded sputum volume, timely sputum suction was carried out. The nature sputum in within 1 week, callus, the amounts of expectoration drainage, lung infection symptoms, sputum culture, blood oxygen activities, and lung function indicators in both groups were observed and compared. The count data were expressed as cases (%), and compared between the two groups by χ² test. The measurement data were expressed as (x±s), and were compared between these two groups by independent-sample t test. Results　The 38 patients in the observation group had taken oxygenation atomization combined with high frequency vibration expectoration 462 times within one week, and 7 cases did sputum culture; the 31 patients in the control group had underwent sputum suction 1 316 times, and 13 cases did sputum culture. The sputum scab rate, sputum purulence rate, expectoration frequency, sputum volume per time, incidence of lung infection, and positive rate of sputum culture were 27.7% (128/462), 21.8% (101/462), (11.0±3.4), (26.0±5.5) ml, 18.4% (7/38), and 42.9% (3/7) in the experimental group, and were 47.6% (627/1 316), 44.7% (589/1 316), (33.0±6.8), (15.0±3.5) ml, 41.9% (13/31), and 76.9% (10/13) in the control group, with statistical differences (P=0.021, 0.016, 0.015, 0.031, 0.017, and 0.036). The rate of conscious patients completing lung function exercise was 86.8% (33/38) in the experimental group, and was 38.7% (12/31) in the control group, with a statistical difference (P=0.038). The sputum volume records showed that the proportion of total sputum volume within 3 days to the total sputum volume in 1 week was 67.8% (8 200/12 100) in the experimental group, and was 51.8% (10 200/19 700) in the control group, with a statistical differences (P=0.452). One week later, the heart rate, respiration, arterial oxygen saturation, partial pressure of oxygen, and lung function in the experimental group were better than those in the control group, but there no statistical differences (all P> 0.05). No one stopped the treatment because of obvious palpitation, shortness of breath, and blood pressure fluctuation. Conclusions　Oxygenation atomization combined with high-frequency vibration expectoration can effectively dilute sputum, prevent sputum scab, and promote sputum excretion. Compared with conventional expectoration, it can significantly reduce the frequency of expectoration and the incidence of lung infection and maximize the coordination with pulmonary function rehabilitation.

Key words: Oxygenation atomization, Vibration expectoration, Tracheotomy, Airway management

摘要： 目的　探讨氧合雾化联合高频振动排痰在气管切开术后气道管理中的应用价值及其对肺功能的影响。方法　回顾分析2020年8月至2021年8月广州新海医院和广东省第一荣军医院共69例因各种原因行气管切开术后患者的临床资料，其中男41例、女28例，年龄31～81岁。随机数字表法分为氧合雾化联合高频振动排痰机组（试验组）38例和常规吸痰组（对照组）31例，根据气道滞留痰液量适时吸痰，观测、比较1周内两组痰液性质、结痂情况、排痰量及肺部感染症状、痰培养、血氧饱活度、肺功能等指标。计数资料以例（百分率）表示，组间比较采用χ²检验；计量资料以（x±s）表示，组间比较采用独立样本t检验。结果　试验组38例患者1周内合计应用氧合雾化联合高频振动排痰462人次，痰培养7例；对照组31例患者1周内合计排痰1 316人次，痰培养13例。试验组气道痰液结痂率为27.7%（128/462）、脓痰率为21.8%（101/462）、排痰频次为（11.0±3.4）次、次均排痰量为（26.0±5.5）ml、肺部感染发生率为18.4%（7/38）、培养阳性率为42.9%（3/7），对照组分别为47.6%（627/1 316）、44.7%（589/1 316）、（33.0±6.8）次、（15.0±3.5）ml、41.9%（13/31）、76.9%（10/13），两组比较，差异均有统计学意义（P=0.021、0.016、0.015、0.031、0.017、0.036）。试验组、对照组意识清醒者配合完成肺功能锻炼率分别为86.8%（33/38）和38.7%（12/31），两组比较，差异有统计学意义（P=0.038）。试验组排痰量记录显示，早期3 d内排痰总量占1周排痰总量比例分别为67.8%（8 200/12 100），对照组为51.8%（10 200/19 700），两组比较，差异有统计学意义（P=0.452）。试验组1周后心率、呼吸及动脉血氧饱和度、血氧分压、肺功能等指标均优于对照组，但差异均无统计学意义（均P>0.05）；全组无因明显心慌、气促、血压波动终止排痰者。结论　氧合雾化联合高频振动排痰可有效稀释痰液、防止痰液结痂、促进痰液排出，较常规吸痰可明显减少排痰频次、降低肺部感染发生率，最大限度配合肺功能康复。

关键词: 氧合雾化, 振动排痰, 气管切开, 气道管理