两种气囊上滞留物引流方法对机械通气慢性阻塞性肺病患者呼吸机相关肺炎的预防  

Prevention of Ventilator Associated Pneumonia by Two Methods of Subglottic Secretion Drainage in Mechanically Ventilated Patients with COPD

作　　者：王亮朝[1] 赵苏[1] 

机构地区：[1]武汉市中心医院呼吸内科,湖北武汉430022

出　　处：《武汉大学学报（医学版）》2011年第1期114-116,128,共4页Medical Journal of Wuhan University

基　　金：武汉市卫生局临床医学科研项目(编号:WX09B05)

摘　　要：目的:探讨有创机械通气治疗的慢性阻塞性肺病(COPD)患者使用气囊上滞留物引流的干预措施能否有效减少COPD患者呼吸机相关肺炎(VAP)的发生率。比较持续囊上引流与间断囊上引流方法在预防VAP效果上的差异及患者耐受性。方法:选取入住我院RICU进行有创机械通气治疗的COPD患者,随机分成对照组、持续气囊上引流组(CSSD)、间断气囊上引流组(ISSD),观察各组间VAP的发病时间、发生率、插管时间,观察患者对两种引流措施的耐受情况,并于机械通气48h起,每3d留取下气道分泌物培养,观察各组间感染菌群的差异。结果:对照组与各引流组之间总体VAP发生率无差异,但1周内,CSSD或ISSD的患者VAP的发生率低于对照组。VAP的发病时间较对照组延迟,但两引流组之间VAP发生率、发病时间无统计学差异。各组间插管时间无差异。两种方法患者耐受均较好,持续气囊上引流患者1例并发有出血。各组之间VAP的感染菌群无差异。与对照组相比,两引流组从下呼吸道分离出的致病菌株较少。结论:有创机械通气COPD患者使用气囊上滞留物引流能够有效的减少较早期VAP的发生,患者耐受好,并发症少,值得临床推广。Objective： To investigate if the methods of subglottic secretion drainage can reduce morbidity of ventilator-associated pneumonia （VAP） in mechanically ventilated COPD patients, and to compare the difference of continuous subglottic secretion drainage （CSSD） and intermittent subglottic secretion drainage （ISSD） in preventing the ventilator-associated pneumonia, and in the patients’ compliance. Methods： The patients were choosed from mechanically ventilated COPD patients in RICU and randomly divided into three groups as control group, CSSD group, and ISSD group respectively. The time of occurrence and the morbidity of VAP, the time of mechanical ventilation, compliance of patients, and bacteriologic results were compared among the three groups. Results： There is no difference in the incidence of VAP among the three groups, but in the first week, the occurrence of ventilator-associated pneumonia was lower, and the time of occurrence of VAP in CSSD group and ISSD group respectively than in control group. The occurrence and time of VAP between CSSD group and ISSD group was not different. There is no difference among the three groups in the time of mechanical ventilation. The compliance of patients to subglottic secretion drainage was good, only one patient with CSSD was found blood in draining fluid. There was no significant difference between the three groups in the spectrum of bacteria, however, less pathogenic bacteria were found in CSSD group and ISSD group. Conclusion： Both CSSD and ISSD can reduce morbidity of VAP in mechanically ventilated COPD patients in first week and delay the occurrence of VAP, and both are safe drainage methods with less complication and good compliance for patients.

关 键 词：肺炎 呼吸机相关 气囊上滞留物引流 慢性阻塞性肺病 预防 

分 类 号：R563.19[医药卫生—呼吸系统]