集束化策略预防呼吸机相关性肺炎  

Clinical study on targeted bundle strategies in prevention of ventilator-associated pneumonia

作　　者：高岩[1] 娄丹蕊[1] 毕宏远[1] 

机构地区：[1]哈尔滨医科大学附属第四医院重症医学科,黑龙江哈尔滨150001

出　　处：《中华医院感染学杂志》2013年第18期4375-4377,共3页Chinese Journal of Nosocomiology

基　　金：黑龙江省科技厅攻关项目(GC09C408-3)

摘　　要：目的研究目标管理下的集束化策略对呼吸机相关性肺炎的预防作用,探讨目标管理在临床集束化治疗实施中的重要作用。方法选取医院重症医学科机械通气患者作为研究对象,将2011年1-8月96例患者作为对照组,2011年9月-2012年8月在目标管理模式下的167例患者作为集束化治疗组,两组治疗模式相同,但集束化治疗组由专人进行监督管理,强化集束化策略的实施。结果集束化治疗组集束化策略6项全部达标56例,占33.5%,4项以上达标者103例,占61.7%,对照组96例患者,集束化策略6项全部达标16例,占16.7%,>4项达标者35例,占36.5%,两组间比较差异有统计学意义(P<0.01);对照组96例患者,发生VAP31例,发生率32.3%,集束化治疗组167例患者,发生VAP22例,发生率为13.2%,两组间比较差异有统计学意义(P<0.05);再插管率对照组略高,但组间比较差异无统计学意义;机械通气时间由(15.8±6.2)d缩短至(11.3±5.1)d,ICU入住时间由(17.5±5.4)d缩短至(14.1±4.6)d,差异有统计学意义(P<0.05)。结论集束化策略可有效预防VAP的发生,目标管理下强化实施可增加该策略的临床依从性,可充分发挥其重要作用。OBJECTIVE To analyze the effect of targeted bundle strategies on prevention of ventilated-associated pneumonia（VAP） and discuss the role of the targeted management in the clinical bundle therapy. METHODS The patients who underwent the mechanical ventilation in the critical care medicine department of the hospital were enrolled in the study, totally 96 patients who were treated between Jan and Aug 2011 were set as the control group, and 167 patients who were treated under the targeted management mode were selected as the bundle treatment group, with the same treatment mode, while the bundle treatment group was supervised by specially-assigned per- son to ensure the implementation of the bundle strategies. RESULTS There were 56 （33.5%） cases with all the 6 projects meeting the standard and 103 （61.7%） cases with more than 4 projects meeting the standard in the bundle treatment group; of 96 cases of patients in the control group, there were 16 （16.7%） cases with all the 6 items meeting the standard and 35（36.5%） cases with more than 4 items meeting the standard, the difference between the two groups was significant（P〈0.01）. The VAP occurred in 31 of 96 patients in the control group with the in- cidence rate of 32.3%; the VAP occurred in 22 of 167 patients of the bundle treatment group with the incidence rate of 13.2 %, the difference between the two groups was significant（P〈0.05） ; the re-intubation rate of the control group was slightly higher than that of the bundle treatment group, without significance the duration of mechanical ventilation shortened from （15.8±6.2）d to（11. 3±5.1）d,and the length of ICU stay reduced from （17.5 ±5.4）d to（14.1±4.6）d, with significance（P〈0.05）. CONCLUSION The targeted bundle strategies can effectively prevent the VAP and increase the compliance of bundle strategies under intensified targeted management with fully playing their important role.

关 键 词：集束化策略 预防 呼吸机相关性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]