新型防喷溅呼吸回路管对机械通气患者VAP及气道多重耐药菌定植的预防作用：一项318例患者前瞻性随机对照干预研究  

Efficiency of novel splash-proof ventilator circuit component on VAP and the colonization of multiple-drug resistant bacteria prevention in patients undergoing mechanical ventilation： a prospective randomized controlled intervention study with 318 patients

作　　者：许嵩翱 郁慧杰[1] 孙辉[1] 朱湘筠 徐小琴[1] 许俊[1] 曹伟中[1] 

机构地区：[1]浙江省嘉兴市第一医院EICU,浙江嘉兴314000

出　　处：《中华危重病急救医学》2017年第1期16-20,共5页Chinese Critical Care Medicine

基　　金：国家实用新型专利（ZL201320211436.6）;浙江省医药卫生科技计划项目（2014KYB270）;浙江省嘉兴市医学重点学科项目（04-F-06）

摘　　要：目的观察新型防喷溅呼吸回路管对机械通气（MV）患者呼吸机相关性肺炎（VAP）及气道内多重耐药菌（MDR）定植是否具有预防作用。方法采用前瞻『生单盲随机平行对照干预性研究方法，选择2014年1月至2016年5月嘉兴市第一医院重症加强治疗病房（ICU）收治的接受MV治疗的330例危重症患者，按随机数字表法平均分为开放式吸痰组、封闭式吸痰组和防喷溅吸痰组。3组患者分别使用普通呼吸回路管、封闭式吸痰装置和新型防喷溅呼吸回路管进行MV及吸痰。记录3组患者VAP发生率，气道细菌、MDR和真菌的定植率，以及MV时间、ICU住院时间、总住院时间、人均住院费用和院内预后。结果在剔除不符合纳入标准、资料不全、中途退出等病例后，最终318例纳入分析。与开放式吸痰组比较，封闭式吸痰组和防喷溅吸痰组总VAP发生率有降低趋势[20．95％（22／105）、21．90％（23／105）比29．63％（32／108）]，但差异无统计学意义（均P〉0．05）；每1000个MV日VAP发生例数也表现出相同的变化趋势（例：14．56、17．35比23．07）。开放式吸痰组和防喷溅吸痰组气道细菌定植率和MDR定植率均明显低于封闭式吸痰组[32．41％（35／108）、28．57％（30／105）比46．67％（49／105），20．37％（22／108）、15．24％（16／105）比39．05％（41／105）]，差异有统计学意义（均P〈0．05）；开放式、封闭式、防喷溅吸痰组真菌定植率分别为4．63％、3．81％、6．67％，但差异均无统计学意义（P〉0．05）。与封闭式吸痰组比较，开放式吸痰组和防喷溅吸痰组MV时间、ICU住院时间和总住院时间均有缩短趋势[MV时间（d）：8．00（4．00，13．75）、8．00（5．00，13．00）比9．00（5．00，16．00），ICU住院时间（d）：10．00（6．00，16．oo）、11．00（7．00，19．00）比13．00（7．50，22．00），总住院时�Objective To investigate the efficiency of closed tracheal suction system （CTSS） using novel splash-proof ventilator circuit component on ventilator-assoclated pneumonia （VAP） and the colonization of multipledrug resistant bacteria （MDR） in patients undergoing mechanical ventilation （MV） prevention. Methods A prospective single-blinded randomized parallel controlled intervention study was conducted. 330 severe patients admitted to the intensive care unit （ICU） of the First Hospital of Jiaxing from January 2014 to May 2016 were enrolled, and they were divided into open tracheal suction group, closed tracheal suction group, and splash-proof suction group on average by random number table. The patients in the three groups used conventional ventilator circuit component, conventional CTSS, and CTSS with a novel splash-proof ventilator circuit component for MV and sputum suction, respectively. The incidence of VAP, airway bacterial colonization rate, MDR and fungi colonization rate, duration of MV, length of ICU and hospitalization stay, and financial expenditure during hospitalization, as well as the in-hospital prognosis were recorded. Results After excluding patients who did not meet the inclusion criteria, incomplete data, backed out and so on, 318 patients were enrolled in the analysis finally. Compared with the open tracheal suction group, the total incidence of VAP was decreased in the closed tracheal suction group and splash-proof suction group [20.95% （22/105）,21.90% （23/105） vs. 29.63% （32/108）], but no statistical difference was found （both P 〉 0.05）, and the incidence of VAP infections/1 000 MV days showed the same change tendency （cases： 14.56, 17.35 vs. 23.07）. The rate of airway bacterial colonization and the rate of MDR colonization in the open tracheal suction group and splash-proof suction group were remarkably lower than those of closed tracheal suction group [32.41% （35/108）, 28.57% （30/105） vs. 46.67% （49/105）, 20.37% （22/108）, 15.24% （1

关 键 词：机械通气 呼吸机相关性肺炎 呼吸回路管 细菌定植 

分 类 号：R459.7[医药卫生—急诊医学]