气管导管气囊上滞留物引流预防呼吸功能不全危重患者医院获得性肺炎的研究  

Research of subglottic secretion drainage in severe respiratory-dysfunction patients receiving tracheostomy to prevent hospital acquired pneumonia.

作　　者：郭发良[1] 卜会驹[1] 阎红霞[1] 杨秀洁[1] 陈亮[1] 秦志梅[1] 温海洋[1] 

机构地区：[1]中山大学附属东华医院重症监护病房,广东东莞523110

出　　处：《中国实用内科杂志》2008年第5期371-373,共3页Chinese Journal of Practical Internal Medicine

基　　金：广东省东莞市科委2005年立项课题(A2005790)

摘　　要：目的观察气管导管气囊上可吸引滞留物对呼吸功能不全行气管切开的危重患者医院获得性肺炎(HAP)的发病、成本及预后的影响。方法选择2004年5月至2006年5月中山大学附属东华医院重症监护病房(ICU)呼吸功能不全的气管切开危重患者120例,将其随机分为气囊上滞留物引流(subballonet secretion drainage,SSD)组60例和未引流组(对照组)60例,记录细菌培养的结果、发生医院内获得性肺炎的时间、气管切开气道开放时间、ICU住院时间。结果SSD组痰液量较对照组明显减少(t=3.304,P<0.05),气囊上滞留物引流量每日达(53±9)mL/d,气囊上滞留物与下呼吸道病原体有一致性和相似的构成比(P>0.05);SSD组HAP发生率、气道开放时间、住ICU时间、总住院时间、患者最后转归等明显优于对照组。结论持续气囊上滞留物引流可以明显降低ICU气管切开危重患者院内感染肺炎发生率,减少气道开放时间,减少ICU住院时间,降低总住院时间及病死率。Objective Research the influence of subjlottic secretion drainage on the incidence, cost and prognosis of hospital acquired pneumonia in severe respiratory dysfunction patients receiving tracheostomy. Methods A total of 120 severe respiratory-dysfunction patients receiving tracheostomy during May 2004 and May 2006 were randomly divided into two groups：Group SSD（ n = 60 ）in which speacial tracheotomy tube with continous subglottic secretion drainage was used, Control group（ n = 60 ）in which normal tracheotomy tube was used. Record the amount and beginning time of hospital acquired pneumonia and bacterial culture results,trachea opening time,and ICU treating time of paitents. Results Sputum capacity of group SSD was obviously smaller than that of control group（ t = 3. 304, P 〈 0. 05 ）. The capacity of subglottic secretion drainage reached several ten milliliters a day（53 ± 9 ）mL/d. Pathogeny of subglottic secretion drainage was similar to that of lower respiratory secretion（ P 〉 0. 05 ）. Group SSD had a lower rate of hospital acquired pneumonia, less trachea opening time, ICU treatment time, and hospitalization time, and lower mortality rate than control group. Conclusion Continous subglottic secretion draining can decrease the rate of hospital acquired pneumonia in severe respiratory-dysfunction patients receiving tracheostomy, reduce trachea opening time, resulting in reduced ICU treating time, hospitalization time and mortality rate.

关 键 词：气管切开术 气囊上滞留物引流 获得性肺炎 医院 

分 类 号：R5[医药卫生—内科学]