简易气囊上引流冲洗在防治呼吸机相关性肺炎的疗效与安全性  

Clinical efficacy and safety of simple subglotfic secretion drainage and flushing on prevention of ventilator-associated pneumonia

作　　者：余长智[1] 吐尔洪.艾萨 吴燕[1] 周燕[1] 

机构地区：[1]石河子大学医学院第四附属医院ICU,新疆阿克苏843000

出　　处：《中华医院感染学杂志》2011年第13期2664-2666,共3页Chinese Journal of Nosocomiology

摘　　要：目的用简易有效的方法降低呼吸机相关性呼吸道感染的发生。方法对入住综合ICU有创呼吸机支持呼吸的320例随机分为试验组(简易气囊上引流试验组)和对照组,两组定期同步对口咽部、气囊上滞留物、导管内壁和下呼吸道分泌物进行细究学检测。结果试验组呼吸机相关性肺炎(VAP)发生34例,显著低于对照组63例(P=0.01);试验组VAP的发生时间(8.8±3.6)d均晚于对照组(4.6±2.0)d,(P<0.002);试验组病死率(10.3%)低于对照组(16.5%);试验组机械通气时间(9±14)d短于对照组(16±15)d,比较差异均有统计学意义(P<0.05);试验组总住院时间(28±25)d与对照组(31±22)d比较,差异无统计学意义。结论简易气囊上引流冲洗可以降低VAP的发生率,可以使VAP的发生时间延迟,病死率降低,机械通气时间缩短。OBJECTIVE To reduce the occurrence of lower respiratory tract infection （LRTI） associated with ventilator by adopting simple and effective methods. METHODS All patients supported by respiratory machine in ICU were divided into two groups ramdonly, one group treated with simple subglotfic secretion drainage and flushing ventilator associated pneumonia （VAP） while other group as control. The total number of cases were 320, which included 225 male and 95 female with the mean age 48 ± 12. Periodically tests were done to two groups for their bacterial culture samples obtained from oropharynx, subglottic secretion and lower respiratory tract, also the time of occurrence of VAP and the case fatality rate were recorded. RESULTS Totally 34 cases occurred VAP in test group , which was significantly lower than that in control group （63 cases） Mortality of treated group （10.3% ） was lower than that of control group （ 16.5 %）. MV time of treated group （9 ±14） d was shorter than that of control group （4.6±2.0）d, （P〈0. 002）. The onset of VAP was delayed in the treated group [VAP： （8.8 ±3.6）d]as compared with the control group [VAP： （4. 6 ±2. 0）d, P〈0. 05]. and statistic data was shown significantly. However, no significantly statistic differences were found in the lengths of hospital stay （28±25）d in treated group and control group （31±22）d, which shown P value for 0. 563. CONCLUSION Simple subglottic secretion drainage and flushing can reduce the incidence of VAP and fatality rate, delay the onset of VAP and shorten MV time.

关 键 词：气囊上滞留物引流 呼吸机相关性肺炎 捆绑优化治疗 机械通气 

分 类 号：R181.32[医药卫生—流行病学]