不同方式声门下吸引对呼吸机相关性肺炎病原菌的影响  

Impact of different modes of subglottic suctions on pathogens causing ventilator-associated pneumonia

作　　者：王宝琴[1] 曹文媚[2] 王莹[2] 马洁[2] 

机构地区：[1]天津市职业病防治院护理部,天津300011 [2]天津市第一中心医院ICU,天津300029

出　　处：《中华医院感染学杂志》2014年第13期3179-3181,共3页Chinese Journal of Nosocomiology

基　　金：天津市卫生局科技基金项目(2010KZ28)

摘　　要：目的探讨不同方式声门下吸引对气管导管的气囊上方分泌物中病原菌影响及其与呼吸机相关性肺炎(VAP)关系。方法采用随机、对照的方法将55例入住ICU行气管插管机械通气的患者分为持续声门下吸引(CASS)治疗组(A组)18例、间断声门下灌洗结合持续声门下吸引(CASS)治疗组(B组)18例及对照组(C组)19例,观察3组VAP发生的病原菌构成和耐药性。结果囊上滞留物共收集165份标本,146份标本培养出病原菌,阳性率为88.5%,共培养病原菌161株,下呼吸道分泌物收集的165份痰标本中47份培养阳性,阳性率为28.5%,共培养出病原菌48株;A与B组、A与C组囊上滞留物病原菌构成相似,B与C组囊上滞留物构成比,差异有统计学意义(P<0.05);B组培养出的多药耐药及泛耐药鲍氏不动杆菌明显少于C组,差异有统计学意义(P<0.01)。结论囊上滞留物培养病原菌以革兰阴性杆菌为主,间断声门下灌洗结合CASS可以改变囊上滞留物的病原菌构成比,减少多药耐药及泛耐药鲍氏不动杆菌在囊上滞留物中的定植。OBJECTIVE To explore the impact of different modes of subglottxc suctions on pamogens lsolateo from secretions of air sac of endotracheal tube and discuss its correlation with ventilator-associated pneumonia （VAP）. METHODS By means of randomized and case-control method, a total of 55 patients who underwent the mechanical ventilation in ICUs were divided into the continuous subglottic suction group with 18 cases （group A）, the inter- mittent suhglottic lavage combined with continuous subglottic suction group with 18 cases （the group B）, and the control group with 19 cases （ group C）, and the distribution and drug resistance of the pathogens causing VAP were observed and compared between the three groups. RESULTS of totally 165 specimens collected from the se- cretions of air sac, 146 have been cultured for the pathogens with the positive rate of 88.5 M ; a total of 161 strains of pathogens have been isolated. Of 165 sputum specimens collected from the lower respiratory tract secretions, 47 were cultured positive with the positive rate of 28.5 %, and 48 strains of pathogens have been isolated. The con- stituent ratios of the pathogens in the group A were similar to the group B and the group C, however, there was significant difference in the constituent ratios of the pathogens isolated from the air sac secretions between the group B and the group C （P〈0. 05）. The multidrug-resistant or pandrug-resistant Acinetobacter baumannii strains cultured in the group B were significantly less than those cultured in the group C, （P〈0.05）. CONCLUSION The gram-negative bacilli are the predominant pathogens cultured from the air sac secretions. The intermittent suhglottic Iavage combined with continuous subglottic suction can change the constituent ratios of the pathogens and reduce the colonization of the multidrug-resistant or pandrug-resistant A. baumannii in the retentate of air sac.

关 键 词：间断声门下灌洗 持续声门下吸引 呼吸机相关性肺炎 多药耐药鲍氏不动杆菌 

分 类 号：R378[医药卫生—病原生物学]