不同稀釋水劑對小容積噴霧器產生霧氣物理特性及效能之影響

前言：小容積噴霧器（Small volume nebulizer, SVN）常用於遞送霧化的藥物至呼吸道及肺部，其效能受霧氣粒子大小、稀釋水劑種類等等因素影響。本研究針對SVN霧化不同水劑稀釋藥物，評估霧化藥物遞送效率的影響。研究方法：Salbutamol 5 mg/2.5 mL，分別加入0.9%氯化鈉水（NaCl）、0.45%NaCl、及蒸餾水（Distilled water, DW）三組稀釋藥物總量至4 ml，再由SVN進行藥物的霧化。由8階撞擊器測試噴霧器產生的霧氣粒徑，另外模擬成人正壓呼吸模式給予霧化藥物，收集吸入藥物百分比、藥杯內殘餘量、霧化時間，計算霧氣輸出、霧氣粒徑之質量中位數氣動粒徑（mass median aerodynamic diameter, MMAD）。紫外線光譜儀分析藥物濃度，換算為吸入藥量百分比。結果：吸入藥量百分比0.9% NaCl組為5.37 ± 0.84%、DW組為4.88 ± 0.75%、而0.45% NaCl組則為 4.85 ± 0.5%（p= 0.452）。殘餘容積則以0.9% NaCl組（1.54±0.15 mL）顯著低於其他兩組（0.45% NaCl：1.87±0.18 mL、DW: 1.75±0.18 mL；p= 0.033），霧化時間各組相似為7.95-8.43分鐘（p = 0.27）。霧氣輸出量以0.9% NaCl組297.26±15.77 uL/min最多、其次0.45% NaCl組252.35±15.44 uL/min、DW組最低184.77±36.09 uL/min（p= 0.035）。SVN出口氣霧粒子的MMAD在0.45% NaCl組為 1.8±0.1 μm顯著小於0.9% NaCl組2.23±0.23 μm、及DW組2.2±0.1 μm（p＜0.001）；但呼吸器遞送SVN藥物霧化粒子的MMAD三組均為1.37 μm，顯著小於SVN出口測得值（p ＜ 0.001）。結論：Salbutamol以0.9% NaCl水稀釋的小容積噴霧器霧化藥物之霧氣輸出量明顯高於其他稀釋液，而殘餘容積顯著低於其他種類稀釋液；霧氣粒徑大於0.45%NaCl但與DW相似。以不同水劑稀釋時，SVN霧化時間、吸入藥量百分比、以及呼吸器傳遞至氣管內管末端之氣霧粒徑則不受稀釋水劑的影響。

關鍵字

霧氣治療；小容積噴霧器；吸入藥量百分比；霧氣輸出量；霧氣粒徑之質量中位數氣動粒徑

並列摘要

Background: Small volume nebulizer (SVN) is commonly used to deliver aerosolized drugs to airways and lungs. The efficiency of small volume nebulizers is affected by numerous factors, yet dilution solution to an SVN on the physical characteristics is seldom explored. Therefore, this study aimed to evaluate various diluents for SVN on aerosol delivery efficiency through mechanical ventilation Methods: A unit-dose bronchodilator, salbutamol 5 mg/2.5 mL, was placed into an SVN, and diluted with 0.9% NaCl, 0.45% NaCl, and distilled water into 4 mL (n=5). We first tested aerosol particle size distribution at the exit of the nebulizer. A simulation of adult ventilated patients was conducted, and inhaled drug dose, residual nebulizer volume, nebulization time, nebulizer output, mass median aerodynamic diameter (MMAD), geometric standard deviation were evaluated. Collected drugs were eluted and assayed by a UV- spectrophotometry, and then drug doses were calculated. Results: Inhaled dose distal to the endotracheal tube were 5.37 ± 0.84% with 0.9% NaCl, 4.85 ± 0.5% for 0.45% NaCl, 4.88 ± 0.75% for distilled water (p = 0.452). The nebulization time were ranged 7.95-8.43 minutes without significant difference (p = 0.27). Salbutamol diluted with 0.9% NaCl generated greatest nebulizer output (297.26 ± 15.77 uL/min), following by 0.45% NaCl (252.35 ± 15.44 uL/min), and then distilled water (184.77 ± 36.09 uL/min; p = 0.035). The mass median aerodiameter (MMAD) were 1.37±0.01 um distal to the ETT for all solutions, yet varied at outlet of the nebulizer (2.2±0.1 um with distilled water, 1.8±0.1 um with 0.45% saline, and 2.23±0.2 um with 0.9% saline; p= 0.026). Conclusions: Dilution solution in an SVN does not influence inhaled drug dose distal to the endotracheal tube and nebulization time but altered the residual volume and nebulizer output. The dilution solution impacted MMAD emitted from an SVN but did not affect particle size distribution delivered distal to the ETT.

並列關鍵字

aerosol therapy ； small volume nebulizer ； inhaled dose percent ； aerosol output ； mass median aerodiameter

國際替代計量

不同稀釋水劑對小容積噴霧器產生霧氣物理特性及效能之影響

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