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Nebulized inhalation therapy is an important treatment method that is widely used in clinical practice. Compared with oral, intramuscular injection, intravenous drip and other administration methods, it has the direct effect of drugs on target organs, rapid onset of action, good curative effect, and fewer systemic adverse reactions. , Simple operation, simple administration, safe and effective, no need for the patient's deliberate cooperation and other advantages.
Nebulized inhalation therapy is mainly to disperse the medicinal solution into fine droplets or particles suspended in the gas as aerosol through the atomization device, and inhale the respiratory tract and (or) lungs through the nose or mouth, so as to achieve anti-inflammatory and swelling , Antispasmodic and antiasthmatic, control infection, thinning phlegm, helping expectorant and other therapeutic effects. The effect of nebulized inhalation therapy is closely related to factors such as driving power, effective nebulized particles, amount of mist released per unit time, absorption of target parts, sedimentation rate in the lungs, and correct breathing methods.
In the process of spray inhalation treatment, some details are very important, not only determining the treatment effect, but also closely related to side effects and safety. Among them is a very important question that is not paid attention to by many people: when spraying inhalation treatment, should I choose a mouthpiece or a nebulizer mask?
In clinical practice, some large hospitals and other medical institutions use mask nebulization as a routine.
However, is it better to use a mouth-mounted atomized inhalation or a mask-based atomized inhalation? Based on my clinical experience and related literature, I will share my views with you.
(1) When using a mouth-containing aerosol inhalation therapy, the drug is directly inhaled through the mouth to reach the lower respiratory tract, when using a face mask atomized inhalation, the drug enters the airway through the nose or mouth, and generally enters the lower respiratory tract through the nasal cavity. In the nasal inhalation pathway, the air flow is significantly smaller than the air flow through the mouth, and the mechanical obstruction in the nose and the existence of many ineffective cavities result in drug retention in the nasal cavity, resulting in drug loss and waste, and a decrease in the deposition rate in the lungs.
That is to say, the amount of inhalation through the mouth is significantly greater than the amount of inhalation through the nose, and the amount of drug deposited in the lungs is greater than the amount of drug deposited through the nose. Therefore, from the perspective of increasing the deposition rate in the lungs and reducing the waste of drugs, the mouth-containing aerosol inhalation has a better effect than the mask-type aerosol inhalation.
(2) Inhalation treatment through a face mask will cause the drug to be retained in the nasal cavity, and many people do not pay attention to the risk of nasal infection when cleaning the nasal cavity; when the face mask is atomized, it will also cause the drug to be absorbed by the facial skin. Various adverse effects such as eye irritation and adsorption to the eyes can cause various side effects. For example, the absorption of hormones on the face may leave facial pigmentation, and the deposition of anticholinergic drugs in the eyes may cause blurred vision and pupils. Scattered and worsening of glaucoma.
(3) In addition, the clinical nebulization is usually driven by an oxygen pump. For patients with COPD and carbon dioxide retention, the inhalation method of mask nebulization can aggravate the adverse consequences of carbon dioxide retention.
Therefore, from the perspective of reducing side effects, the same mouth-containing aerosol inhalation method is more advantageous.
In the literature reviewed, more studies have shown that the treatment effect (improvement of lung function, symptom improvement, etc.) of inhalation through a mouth-mounted atomized inhalation is more significant and has fewer side effects than that of inhalation through a mask. Mouth atomized inhalation method is recommended as the first choice.
of course not.
In some special cases, the mask type atomization can be more effective than the mouth type atomization inhalation method, such as the following situations:
(1) Those who cannot cooperate with the mouth-type nebulizer because of their youth or intelligence and understanding; or those who have lower respiratory tract diseases with allergic rhinitis or adenoid hypertrophy, the effect of assisted inhalation with a mask is better.
(2) For most elderly patients (such as chronic obstructive pulmonary disease patients> 70 years old) due to weak limb muscle strength and insufficient breathing self-regulation ability, the hand is unstable, or even unable to hold the reservoir, resulting in improper cooperation and elderly patients Hearing loss is more obvious, the comprehension ability is not strong, and the coordination of verbal instructions is not good. It is relatively difficult to master the use of mouth-type nebulizer inhaler. In these cases, the effect of mask-type aerosol inhalation therapy is better than that of mouth-type aerosol inhalation.
(3) According to the results of clinical investigations and studies, patients who cannot properly grasp or use the mouth-type nebulizer method in nebulization treatment, the mouth-type nebulizer method is poor, and it is recommended to use mask-type nebulization inhalation therapy.
(4) In addition, for patients with obvious hypoxia and no carbon dioxide retention, because face mask nebulization is more conducive to improving hypoxia than mouth-type nebulization, face mask nebulization inhalation can be considered.
Although the use of mask aerosol inhalation device for aerosol inhalation, patients are easy to grasp, have good compliance, and are more easily accepted by patients and their families. It can effectively improve the condition-especially for poor cardiopulmonary function, poor active coordination ability, and neurological diseases Patients with weakened limb muscles have a good advantage, but in the process of using the mask-type oxygen atomization inhalation method, it is also necessary to pay attention to the tightness of the mask and observe the patient's vital signs and changes in the condition.
Even if you use a mask for aerosol inhalation, you should instruct the patient to inhale it through the mouth as much as possible; pay attention to maintaining the proper tightness of the mask. Proper tightness can not only increase the amount of aerosol inhaled, but also reduce the risk of aerosolized drugs entering the eyes. If the mask is too tight, it will cause discomfort to the patient. Generally, there can be about 0.5 cm gap between the mask and the face. After the atomization is over, the face should be cleaned to reduce the absorption of the drug on the face and absorption through the skin. It is also necessary to rinse the mouth, and even pay attention to cleaning the nasal cavity.
Nebulized inhalation therapy is an ideal common route of administration for respiratory diseases. It is suitable for a wide range of people and is widely used in internal medicine, pediatrics, surgery (perioperative airway management), otolaryngology, pregnant women, etc. Professional department.
Clinical medical staff, patients and parents of children should fully understand the benefits of standardized aerosol inhalation therapy to patients, master the standardized use of aerosol devices related to aerosol inhalation therapy, and optimize the treatment plan, which will more effectively improve the clinical efficacy, reduce side effects and increase safety.