持续声门下吸引对呼吸机相关性肺炎及再插管率的影响  

Influence of continuous aspiration of subglottic secretions on ventilator-associated pneumonia and reintubation rate

作　　者：谢丽娟[1] 蒋勇[1] 黄伟强[1] 黄世英[1] 李翠玲[1] 

机构地区：[1]广东省英德市人民医院重症医学科,广东英德513000

出　　处：《中国当代医药》2014年第35期157-159,共3页China Modern Medicine

基　　金：广东省英德市人民医院科研项目(H2014-10)

摘　　要：目的前瞻性研究持续声门下吸引对呼吸机相关性肺炎(VAP)及再插管率的影响。方法选择经口气管插管机械通气患者230例,将其随机分为治疗组和对照组,治疗组气管插管采用带声门下吸引管气管导管,插管后采用持续声门下吸引至拔管;对照组未采用持续声门下吸引直至拔管。观察两组的5 d内脱机病例数及其VAP发生率、24 h内再插管率;5天以上脱机病例数及其VAP发生率、24 h内再插管率;机械通气时间。结果治疗组的5 d内脱机患者率明显高于对照组(P<0.01),治疗组5 d内脱机患者的VAP发生率低于对照组(P<0.05),两组5 d内脱机患者的24 h内再插管率差异无统计学意义(P>0.05);治疗组的5 d以上脱机患者率低于对照组(P<0.01),两组5 d以上脱机患者的VAP发生率差异无统计学意义(P>0.05),治疗组5 d以上脱机患者的24 h内再插管率明显高于对照组(P<0.05)。治疗组的机械通气时间短于对照组(P<0.01)。结论持续声门下吸引能降低VAP发生风险,但可能因气道损伤增高再插管率,尤其是对需机械通气较长时间的患者。Objective To prospectively study the influence of continuous aspiration of subglottic secretions（CASS） on ventilator-associated pneumonia（VAP） and reintubation rate. Methods 230 mechanically ventilated patients through oral trachea cannula were randomly divided into the treatment group and control group.Tracheal catheter of subglottic suction tube was applied in tracheal intubation of the treatment group,CASS was used after intubation until extubation,while CASS was not used until extubation in the control group.case load of offline within 5 days,and the incidence rate of VAP,reintubation rate within 24 hours for offline patients within 5 days in the two groups,and case load of offline for more than 5 days,and the incidence rate of VAP,reintubation rate within 24 hours for offline patients for more than 5days in the two groups were observed. Results The rate of offline patients within 5 days in the treatment group was higher than that in the control group（P〈0.01）,and for offline patients within 5 days,the incidence rate of VAP in the treatment group was lower than that in the control group（P〈0.05）,and there was no statistical difference of the reintubation rate within 24 hours in the two groups（P〉0.05）.The rate of offline patients for more than 5 days in the treatment group was lower than that in the control group（P〈0.01）,and for offline patients for more than 5 days,and there was no statistical difference of incidence rate of VAP in the two groups（P〉0.05）,reintubation rate within 24 hours in the treatment group was lower than that in the control group（P〈0.05）.The duration of mechanical ventilation in the treatment group was shorter than the control group（P〈0.01）. Conclusion CASS can reduce the risk of VAP occurrence,but may damage the airway and increase reinbutation rate,especially for those patients with mechanical ventilation in a longer time.

关 键 词：持续声门下吸引 呼吸机相关性肺炎 再插管率 

分 类 号：R563.19[医药卫生—呼吸系统]