气囊上滞留物引流对呼吸机相关肺炎发病的影响  

Influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients

作　　者：柏宏坚 何礼贤[2] 瞿介明[2] 胡必杰[2] 张杏怡[2] 陈雪华[2] 潘珏[2] 董荔[2] 

机构地区：[1]江苏省盐城市第一人民医院呼吸科,224001 [2]上海医科大学中山医院肺科,200032

出　　处：《中华结核和呼吸杂志》2000年第8期472-474,共3页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的　观察气囊上滞留物引流对呼吸机相关肺炎 (VAP)发病的影响。方法　对入住外科重症监护病房需气管插管患者使用特制的可吸引气管导管 ,并将病例随机分成气囊上滞留物引流组 (引流组 35例 )和非引流组 (非引流组 33例 )。定期对口咽部、气囊上滞留物和下呼吸道分泌物进行细菌学检测 ,记录患者机械通气时间、气囊上滞留物的引流量和发生VAP的病例数 ,依据防污染毛刷采样 (PSB)定量培养结果确定VAP的病原体。结果　引流组VAP发生率 (2 3% )低于非引流组(45 % ) (P <0 0 5 ) ,气囊上滞留物引流能降低革兰阳性球菌和流感嗜血杆菌引起的VAP发生率 ,而对非发酵菌引起的VAP发生率无明显影响。气管插管后 ,引流组VAP发生的时间 (14± 8天 )迟于非引流组 (6± 4天 ) (P <0 0 5 )。在VAP患者中 ,6 1% (14/ 2 3)VAP病原体与VAP发生前从气囊上滞留物中分离得到的病原体相同。结论　气囊上滞留物是VAP病原体的重要来源。气囊上滞留物引流方法简便 ,可延迟VAP的发生并降低气管插管患者的VAP发生率 ,尤其是革兰阳性球菌和流感嗜血杆菌所致VAP的发生率。Objective To assess the influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients Methods All cases requiring intubation in SICU were intubated with a special type endotracheal tube which has a small bore cannula in its wall for subglottic secretion drainage. They were randomly divided into two groups received subglottic secretion drainage(SSD) and usual care(NON SSD) respectively Bacterial culture of samples from the oropharynx, subglottic secretions and lower respiratory tract were obtained periodically The amount of subglottic secretion aspirated daily, ventilated days and the number of cases with VAP were recorded Etiologic diagnosis of VAP was based on the quantitative bacterial culture of secretions obtained by protected specimen brush(PSB) Results The morbidity of VAP in the SSD group ( n =35) (23%) was lower than that in the NON SSD group ( n =33) (45%) ( P <0 05) The difference was due to the significant reduction of VAP caused by gram positive cocci and Haemophilus influenzae organisms However, no difference was observed in the incidence of VAP caused by non fermental bacteria After intubation the onset of VAP was delayed in SSD group (14±8 day) as compared with the NON SSD group (6±4 day) ( P <0 05) The same organisms were isolated by PSB among 61% (14/23)patients with VAP as what were previously isolated from the subglottic secretions Conclusions The presence of subglottic secretion may be an origin of the pathogenetic organisms of VAP The morbidity of VAP in mechanically ventilated patients can be reduced by SSD, especially for VAP caused by gram positive cocci and Haemophilus influenzae organisms SSD may be a simple and effective method for prevention of VAP

关 键 词：气囊上滞留物 引流 呼吸机相关肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]