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題名 | Heliox 在阻塞性肺疾之應用=Clinical Application of Heliox in Obstructive Lung Disease |
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作者 | 陳奕仁; 薛尊仁; Chen, I-jen; Hsiue, Tzuen-ren; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20000100 |
卷期 | 2:1 2000.01[民89.01] |
頁次 | 頁85-90 |
分類號 | 415.428 |
語文 | chi |
關鍵詞 | 氦氧混合氣; 阻塞性肺疾; 氣喘症; 上呼吸道阻塞; 氣體密度; Heliox; Obstructive lung diseases; Asthma; Upper airway obstruction; Gas density; |
中文摘要 | Heliox是氦氧混合氣,一般使用為80%氦氣-20%氧氣或70%氦氣-30%氧氣。由於氦氣分子量為4,氧分子量為32,及氮分子量為28,因此Heliox之密度為空氣之三分之一。根據流體力學之原理,氣體在管内之流動,如果為擾流時,其阻力是和氣體密度相關,即氣體密度愈小,阻力愈小,流速愈快。由於氣體在分岔多之人體氣道内流動,尤其在前十代氣道分岔前,擾流居多。利用此種特性,Heliox可應用於阻塞性肺疾之治療。 最早使用Heliox來治療阻塞性肺疾為Barach醫師在1934年發表文章發現在氣喘急性發作及上呼吸道阻塞時吸入Heliox可減輕呼吸困難之情形。隨後由於呼吸器之發明,此一治療便被逐漸忽略了。直到近來,由於插管及使用呼吸器等侵襲性治療有其併發症,因此使用Heliox又逐漸被重視,而在近年來有許多文章探討其在臨床上之應用。Heliox在臨床上之應用主要應用於三方面:一、氣喘急性發作併呼吸酸中毒時可降低PaCO₂及減少呼吸作功,而減少插管使用呼吸器之機會;二、上呼吸道阻塞尤其是拔管後之聲門水腫引起狹窄及兒童之Croup症狀之減緩;三、利用Heliox來做為驅動藥物噴霧之氣體,可使得藥物更可以達到肺部之深處,而使呼吸流速之增加更為顯著。雖然Heliox可減緩症狀,但其並不會改善根本之障礙,其主要功能只是利用其特殊物理性質來"買時間",讓根本之障礙在此段期間可經由藥物來消除或改善。Heliox相對而言並不便宜,其是否能成為常規使用,尚須更多之臨床報告來佐證。 |
英文摘要 | Heliox is a mixture of helium and oxygen. The heliox usually contains 70%-80% helium and 30%-20% oxygen. Heliox is a low density gas mixture, and its density is about one third of the air. According to the principle of gas dynamics, the airflow in the human central airways is turbulent flow which is density dependent. The airway resistance will decrease and the airflow will increase when the density of inhaled gas decrease. Using this characteristic, heliox can be used as a non-pharmacological management of obstructive airway disease. Heliox was found to improve airflow and relieve dyspnea in severe asthma and upper airway obstruction in 1934 by Barach. In 1959, Grape et al. demonstrated that respiratory resistance decreased when heliox was applied to the patient with emphysema. The use of heliox was discontinued due to the invention of positive pressure ventilator. However, due to the invasiveness and side effects of tracheal intubation and mechanical ventilation, the use of heliox has been re-recognized and some reports have demonstrated its effectiveness recently. Recent evidence suggest that we can apply heliox in three conditions. The first condition is to relieve the dyspnea and prevent the endotracheal intubation in severe asthma attack. The second condition is to relieve the symptom in patients with acute upper airway obstruction such as post-extubation stridor or croup. The third condition is to use heliox as a delivery gas to nebulize the drug, which will result in more deposition of the drug in the deeper airways. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。