应用密闭式双加热丝式呼吸机湿化管道细菌培养分析  

Cultures of respiratory tracts and ventilator circuits as humidified with closed double-heater-wire circuits

作　　者：蓝惠兰[1] 陈瀚熙[1] 谭杏飞[1] 张秀浓[1] 梁大连[1] 王媚[1] 

机构地区：[1]广东省人民医院急危重症医学部ICU,广州市510080

出　　处：《中华护理杂志》2010年第9期787-789,共3页Chinese Journal of Nursing

基　　金：广东省医学科研基金项目(编号:A2009013)

摘　　要：目的分析密闭式双加热丝式呼吸机湿化管道对呼吸道及呼吸机管道细菌的影响。方法选择2008年3月至2010年3月30例,在ICU建立人工气道使用一次性密闭式双加热丝式呼吸机湿化管道系统机械通气336h以上的患者,分别于上机1h、72h、168h、240h、336h采样;采样部位分别为患者的咽峡部、下呼吸道、呼吸机管道送气端、湿化罐湿化液;对采样标本进行细菌培养,分离菌落数与细菌培养阳性率,观察不同部位,不同时间段实验室检查及细菌学变化。结果呼吸道与呼吸机管道细菌定植以鲍曼不动杆菌和铜绿假单胞菌为主,占57.50%。呼吸机管道与呼吸道定植菌具有同源性;呼吸道不同采样时间的细菌培养阳性率与呼吸机管道相同部位不同采样时间的细菌阳性检出率差异无统计学意义;延长呼吸机湿化罐使用时间湿化罐内湿化液细菌无增加。结论延长使用一次性密闭式双加热丝式呼吸机湿化管道系统至336h,呼吸道及呼吸机管道系统细菌随时间增加差异无显著性;持续使用一次性密闭式双加热呼吸机湿化管道系统的湿化罐及湿化液336h内无需更换。Objective To analyze the positive cultures of respiratory tracts,ventilator circuits and humidify devices in patients ventilated.Methods From March of 2008 to March of 2010,30 patients receiving mechanical ventilation with the hot-water humidification with double-heater-wire （DHW） more than 336 hours were recruited.The specimen for bacterial culture were collected from pharyngeal isthmus,lower respiratory tracts,gas delivery tubes and water in humidifier water reservoirs 1,72,168,336 hours after ventilated,respectively.Results Acinetobacter baumannii and pseudomonas aeruginosa were mainly bacteria of respiratory tract and ventilator circuit,which accounted for 57.50%.The bacterial colonization in the respiratory tract and bacteria from ventilator circuits and were homologous.No significant difference was found in the positive culture rates of ventilator circuits at different times,while significant difference was found in those of respiratory tracts.Conclusion There was no increase of bacteria in gas delivery tubes and water in humidifier water reservoirs during 336 hours while pa-tients receiving mechanical ventilation,and the humidification circuits and humidifier water reservoirs need not changed within 14 days during continuous use of DHW.

关 键 词：细菌定植 肺炎 呼吸机相关性 呼吸机管道 

分 类 号：R563.1[医药卫生—呼吸系统]