气囊上滞留物冲洗对预防呼吸机相关肺炎的作用  

Effect of subglottic secretion drainage on the prevention of ventilator associated pneumonia

作　　者：张淑香[1] 解建[1] 张子强[1] 

机构地区：[1]山东省千佛山医院ICU,济南250014

出　　处：《中国实用护理杂志》2008年第3期23-25,共3页Chinese Journal of Practical Nursing

摘　　要：目的观察气囊上滞留物冲洗对预防呼吸机相关肺炎（VAP）的作用。方法对入住重症监护病房（ICU）预行机械通气（MV）超过48h的患者使用可冲洗型气管导管，共进行63例次。采用随机数字表法分为2组，即气囊上滞留物定期引流冲洗组为A组（31例次），非冲洗组为B组（32例次）。A组每6h冲洗1次，B组于机械通气后48h、4，7，14d取标本时冲洗。分别于机械通气后48h、7，14d采用双套管保护性毛刷取下呼吸道分泌物，同步行气囊上滞留物细菌学检测，并进行2组间比较。结果1周内，A组VAP的发生率为6．1％，与B组31．3％相比明显降低，差异有统计学意义（P〈0．05），1周后，2组VAP的发生率相比差异无统计学意义（P〉0．05）。A组VAP的发生时间较B组明显延迟，差异有统计学意义（P〈0．01）。A组气囊上滞留物致病菌的浓度明显低于B组（P〈0．01）。在发生VAP的22例次患者中，气囊上滞留物与下呼吸道分泌物菌株分布一致的患者有13例次，占61．1％。主要优势菌依次为铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、嗜麦芽窄食假单胞菌。结论（1）气囊上滞留物引流和冲洗可以使气囊上滞留物致病菌的浓度明显降低，还可以降低VAP的发生率，使VAP的发生时间延迟。（2）气囊上滞留物病原菌移行是VAP的重要原因之一。Objective To assess the influence of subglottic secretion drainage（SSD） on the prevention of ventilator associated pneumonia （VAP）. Methods 63 patients in the intensive care unit（ICU） who received mechanical ventilation above 48 hours were divided into two groups named group A （31 cases） and group B （32 cases）.Group A received SSD 1 time per 6 hours while group B only got SSD at 48 hours, the 4th,7th and 14th days when samples were got. We brushed away secretion from airway and also monitored bacteriology of the subglottic secretion between the two groups. Results The incidence rate of VAP in group A was 6.1% and was evidently lower than that of group B（P 〈0.05）, which was 31.3% within 1 week. But 1 week later the incidence rate of VAP in the two groups was not statistically different （P 〉 0.05 ）.The onset time of VAP was later and the bacteria number in the subglottic secretion was less in group A than those in group B （P 〈0.01 ）.The same bacteria strain was found in the subglottic secretion and air- way secretions in 13 patients out of 22 VAP patients. The dominant bacteria were P. aeruginosa, K. pneumonia, Staphylococcus aureus and Pseudomonas stenotrophomonas. Conclusion SSD could reduce the bacteria concentration in subglottic secretion, decrease VAP incidence and delay the onset of VAP. Migration of dominant bacteria from the subglottic secretion was one of the important causes of VAP.

关 键 词：呼吸机相关肺炎 气囊上滞留物冲洗 重症监护病房 

分 类 号：R473.56[医药卫生—护理学]