痰热清注射液冲洗人工气道球囊对预防呼吸机相关性肺炎的作用  

Effects of irrigating artificial airway gasbag with Tanreqing injection on preventing 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] 

机构地区：[1]浙江中医药大学附属第二医院重症医学科,浙江杭州310005

出　　处：《中华医院感染学杂志》2014年第3期635-637,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科学研究基金项目(2012ZB063)

摘　　要：目的研究气管导管气囊上行痰热清注射液冲洗对抑制机械通气患者气道病原菌,预防呼吸机相关性肺炎(VAP)的作用。方法对ICU收治的72例气管导管机械通气患者常规对症治疗,随机分为对照组Ⅰ、Ⅱ及试验组各24例,对照组Ⅰ应用无菌生理盐水每12h行1次气囊冲洗,对照Ⅱ组不进行气囊冲洗,试验组用痰热清注射液10ml行同样的气囊冲洗,持续治疗观察15d;检测患者气管导管囊滞留物及下呼吸道分泌物的病原菌分布,统计各组VAP发生、机械通气及住ICU时间。结果治疗15d后,试验组患者囊滞留物中铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌检出率为16.67%、12.50%、8.33%与治疗前54.17%、41.67%、29.17%比较均明显减少,且均显著低于对照组Ⅰ、Ⅱ,差异均有统计学意义(P<0.05);下呼吸道分泌物中铜绿假单胞菌、鲍氏不动杆菌的检出率为8.33%、4.17%与治疗前45.83%、29.17%比较明显减少,且试验组病原菌检出株数均显著低于对照组Ⅰ、Ⅱ,差异有统计学意义(P<0.05);试验组发生VAP例数均明显少于对照组Ⅰ、Ⅱ,患者机械通气天数及入住ICU天数均比对照组Ⅰ、Ⅱ有显著下降,差异有统计学意义(P<0.05)。结论痰热清注射液进行气管导管气囊冲洗能减少机械通气患者气道病原菌生存,降低VAP发生率。OBJECTIVE To explore the effect of irrigating artificial airway gasbag with Tanreqing injection on preventing respiratory tract pathogenic bacteria and ventilator associated pneumonia （VAP）. METHODS A total of 72 cases of ICU patients treated with tracheal catheter mechanical ventilation were given routine therapy, who were randomly divided into control Ⅰ , controlⅡ and test group, 24 cases in each group. Control Ⅰ group received gasbag irrigation with sterile saline once in 12 h, control Ⅱ group was no irrigation, and test group received Tanreqing injection （10 ml） irrigation to gasbag. All of the treatments were under observation for 15 days. The retentate from the airway gasbag and the pathogenic bacteria distributed in lower respiration secretion in all patients were detected. The incidence of VAP, period of mechanical ventilation and ICU stay were determined. RESULTS After 15 d of treatment, Pseudomonas aeruginosa, Acinetobacter baumannii, and K lebsiella pneumoni- ae detected from retentate on the gasbag were significantly decreased from 16. 67%, 12. 50% and 8.33% to 54.17%, 41. 67% and 29. 17% compared with the pretreatment in test group patients, which were also significantly lower than that of control Ⅰ and Ⅱ groups （P〈0.05）. P. aeruginosa and A. baumannii detected from lower respiration secretion were significantly lower than pre-treatment from 8. 33% and 4. 17% to 45.83% and 29.17% in test group patients, which were also significantly lower than that of control Ⅰ and Ⅱ groups （P〈 0.05）. The incidence of VAP, periods of mechanical ventilation and ICU stay in Test group were all reduced significantly compared with control Ⅰ and Ⅱ groups （P〈0.05）. All the measurements between control Ⅰ and Ⅱwere no significant differences after treatment. CONCLUSION Irrigating tracheal catheter gasbag with Tanreqing injection can effectively reduce the respiratory tract infection of pathogenic bacteria and the incidence of VAP in pa-tients with mechanical ventilation.

关 键 词：痰热清注射液 气管导管 气囊冲洗 机械通气 病原菌 呼吸机相关性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]