痰热清注射液冲洗气管导管对预防呼吸机相关性肺炎的临床研究  

Preventive effect of irrigating endotracheal tube with Tanreqing injection on ventilator associated pneumonia

作　　者：陆军[1] 赵滋苗[1] 王飞[1] 丁月平[1] 叶肖琳[1] 马丹女[1] 宋希玲[1] 

机构地区：[1]浙江省新华医院重症监护室,杭州310005

出　　处：《中华危重症医学杂志（电子版）》2013年第5期12-15,共4页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：2012年浙江省中医药科学研究基金计划(2012ZB063)

摘　　要：目的研究痰热清注射液冲洗气管导管对机械通气患者发生呼吸机相关性肺炎(VAP)的预防作用。方法选择2012年3月至2013年8月浙江省新华医院重症监护室(ICU)收治并行气管插管机械通气患者60例,将患者随机分为实验组、对照组Ⅰ组和对照Ⅱ组,各20例。实验组用10 ml痰热清注射液而对照Ⅰ组用等量无菌生理盐水行气管导管冲洗,每12小时一次,对照Ⅱ组不冲洗。分别在入院时、治疗第7天及第15天时测量患者体温,检测白细胞计数(WBC)、中性粒细胞比值、C反应蛋白(CRP)、降钙素原(PCT)水平,记录各组进行机械通气天数、住ICU天数及VAP发生例数,比较组间差异。结果每个时间点各组间体温差异均无统计学意义。治疗第7天,实验组的WBC、中性粒细胞比值、CRP及PCT上升程度明显低于对照组(P均<0.05)。治疗第15天,实验组的各项指标回落至与治疗前无明显差异(P均>0.05)。与对照组比较,实验组患者的机械通气天数、住ICU天数及发生VAP例数均明显减少(P均<0.05)。对照组Ⅰ组与对照Ⅱ组之间的各项指标在治疗后均无显著差异(P均>0.05)。结论痰热清注射液进行气管导管冲洗能减少机械通气患者炎症反应的发生,降低VAP的发生率。Objective To investigate the preventive effect of irrigating endotracheal tube with Tanreqing injection on ventilator associated pneumonia （VAP） in patients with mechanical ventilation. Methods The patients receiving endotracheal intubation mechanical ventilation in the intensive care unit （ICU） of Xinhua Hospital of Zhejiang Province between March 2012 and August 2013 were enrolled in the retrospective study. They were randomly divided into the experiment group, control group I and control group Ⅱ , 20 cases in each group. The endotracheal tubes of the patients in the experiment group and control group I were respectively irrigated with Tanreqing injection and sterile saline administered at a volume of 10 ml every 12 hours, while in the control group Ⅱ without a washout. Of all the patients, the body temperature, ratio of neutrophils, the levels of white blood cell （WBC）, C reactive protein （CRP） and procalcitonin （PCT） were measured at the day of admission, the 7th and 15th day of treatment. The incidence of VAP, the duration of mechanical ventilation and ICU stay were also recorded and compared between the groups. Results There were no statistical differences in body temperature between the groups at the 3 time points. The levels of the blood indices in the experiment group rose obviously less at the 7th and the 15th day of treatment than those in the control groups （all P〈0.05）, even recovered on the 15th day. The incidence of VAP, the duration of mechanical ventilation and ICU stay in the experiment group were all reduced compared with the controlgroups （all P〈 0.05）. No significant differences were found in all the indices between control groups I and Ⅱ after treatment Conclusion Irrigating endotracheal tube with Tanreqing injection could reduce inflammation in patients with mechanical ventilation, thereby prevent the incidence of VAP.

关 键 词：痰热清注射液 气管导管气囊上冲洗 机械通气 呼吸机相关性肺炎 

分 类 号：R259[医药卫生—中西医结合]