有创呼吸机管路系统不同更换周期与呼吸机相关性肺炎发生的关系  

Invasive ventilator piping system replacement cycle with different ventilator associated pneumonia occurred in relation

作　　者：张丽[1] 尹健[1] 邵丽萍[1] 刘璐[1] 

机构地区：[1]新疆医科大学附属中医医院呼吸ICU,乌鲁木齐830011

出　　处：《新疆医科大学学报》2013年第11期1628-1630,共3页Journal of Xinjiang Medical University

基　　金：新疆医科大学科研创新基金(xjc201179)

摘　　要：目的探讨有创呼吸机管路系统不同更换周期与呼吸机相关性肺炎(VAP)发生的关系,确定适合的机械通气患者呼吸机管路的更换周期。方法选择96例呼吸衰竭需建立人工气道进行机械通气的患者,采取呼吸机管路及湿化装置,分别间隔3、5、7d更换,分为3d组、5d组、7d组,分别对呼吸机管路的集水杯进行采样和细菌学检测,同时观察3d组患者发生VAP的情况。结果 96例患者中共分离出34 096株病原菌,革兰氏阳性菌6 226株(18%),革兰氏阴性菌27 870株(82%),发生VAP 70例(24.31%)。3d组2 183株(6%),革兰氏阳性菌437株(1%),革兰氏阴性菌1 746株(5%),发生VAP 7例(7.29%);5d组7 753株(23%),革兰氏阳性菌1 383株(4%),革兰氏阴性菌6 370株(19%),发生VAP 15例(15.63%);7d组24 160株(71%),革兰氏阳性菌4 406株(13%),革兰氏阴性菌19 754株(58%),发生VAP 48例(50.00%)。7d组VAP的发病率明显高于3d组、5d组,差异有统计学意义(P<0.05),3d组和5d组比较差异无统计学意义。结论呼吸机管路更换时间与VAP发生率相关,建议7d至少更换1次呼吸机管路,可以降低VAP的发生率。Objective To study the relationship between different replacement cycle of breathing machine pipeline system and ventilator associated pneumonia （VAP）, also determine the suitable mechanical venti- lation pipe replacement cycle for patients with ventilator. Methods 96 patients with respiratory failure who need artificial airway to achieve mechanical ventilation used breathing machine line spacing and wet- ting device. The replacement intervals were three days, five days, 7 days respectively. And three groups were established, namely, 3-day group, 5-day group, 7-day group and samples were collected respectively from glasses of breathing machine line set. The bacteriology were observed, and VAP in 3-day group were examined at the same time. Results 34 096 strains of pathogenic bacteria from a total 96 of patients were isolated, with 6 226 strains of gram-positive bacteria accounting for 18%, 27 870 strains of gram-negative bacteria accounting for 82% and 70 cases with VAP, accounting for 72.9% ; 3-day group had 2 183 plants （6 %） with 437 strains of gram-positive bacteria accounting for 1%, 1 746 strains of gram-negative bacteria accounting for 5%, 7 cases with VAP accounting for 7.29%; 5-day group had 7 753 strains accounting for 23%, 1 383 strains of gram-positive bacteria accounting for 4%, 6 370 strains of gram-negative bacteria ac- counting for 19% and 15 cases with VAP accounting for 15.63%; among them 7-day group had 24 160 plants accounting for 71%, 4 406 strains of gram-positive bacteria accounting for 13%, 19 754 strains of gram-negative bacteria accounting for 58% and 48 cases with VAP accounting for 50%. The incidence of VAP in 7-day group was obviously higher than that of 3-day and 5-day groups, the difference was statisti- cally significant （P 〈0.05）. There was no significant difference between 3-day group and 5-day group. Conclusion The time of breathing machine pipeline replacement was associated with the incidence of VAP. This study suggests that the breathing machine pipeline should

关 键 词：机械通气 呼吸机管路 呼吸机相关性肺炎 

分 类 号：R473[医药卫生—护理学]