锥形气囊气管导管预防急性心肌梗死合并呼吸衰竭患者呼吸机相关肺炎的效果分析  

Effect of conical balloon tracheal tube in preventing ventilator-associated pneumonia in patients with acute myocardial infarction complicated with respiratory failure

作　　者：吴文静[1] 王金柱[1] 骆晓攀[2] 陈娟红[1] 姚惠萍[1] WU Wenjing;WANG Jinzhu;LUO Xiaopan;CHEN Juanhong;YAO Huiping(Department of Intensive Care Unit,Zhejiang Provincial People＇s Hospital,Affiliated People＇s Hospital of HangzhouMedical College,Hangzhou 310014,China;Department of Anesthesiology,Zhejiang Provincial People＇s Hospital,Affiliated People＇s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院重症医学科,浙江杭州310014 [2]浙江省人民医院杭州医学院附属人民医院麻醉科,浙江杭州310014

出　　处：《中国现代医生》2018年第29期4-8,共5页China Modern Doctor

基　　金：浙江省教育厅一般科研项目(Y201534508);浙江省医药卫生一般研究计划(2015KYB014)

摘　　要：目的探讨锥形气囊气管导管预防急性心肌梗死(AMI)合并呼吸衰竭患者呼吸机相关肺炎(VAP)的临床效果。方法选择160例AMI合并呼吸衰竭患者为研究对象并按照随机原则分为对照组和观察组,每组80例。所有患者均接受经口气管插管接呼吸机辅助通气治疗,其中对照组患者采用传统的圆形气囊气管导管,观察组采用新型的锥形气囊气管导管。气管插管期间两组患者均实施VAP集束化护理策略。比较两组患者VAP发生情况、痰液变化量、声门下分泌物变化量、临床肺部感染评分(CPIS)、机械通气时间、ICU停留时间及住院费用差异。结果观察组患者VAP发生率明显低于对照组,而平均诊断VAP时间则明显大于对照组,差异均有统计学意义(P均<0.05)。观察组痰液变化量和声门下分泌物变化量明显多于对照组,入科第7天时观察组患者CPIS明显低于对照组,且机械通气时间、ICU停留时间及ICU住院费用均明显少于对照组,差异均有统计学意义(P均<0.05)。结论锥形气囊气管导管能够明显减少声门下分泌物及误吸,降低急性心肌梗死合并呼吸衰竭患者VAP的发生率,缩短机械通气时间并减少ICU停留时间,值得在临床中推广应用。Objective To investigate the clinical effect of conical balloon tracheal tube in preventing ventilator-associated pneumonia（VAP） in patients with acute myocardial infarction （AMI） complicated with respiratory failure. MethodsA total of 160 patients with AMI complicated with respiratory failure were enrolled and divided into control group andobservation group according to the random principle, with 80 cases in each group. All patients underwent transgastricintubation and ventilator-assisted ventilation. The control group used a conventional round balloon tracheal cannula.And the observation group used a new type of conical balloon tracheal cannula. VAP clustering nursing strategies wereimplemented in both groups during tracheal intubation. The VAP incidence, sputum changes, subglottic secretionchanges, clinical pulmonary infection score（CPIS）, mechanical ventilation time, ICU stay time, and hospitalization costwere compared between the two groups. Results The incidence of VAP in the observation group was significantly lowerthan that in the control group, and the mean time to diagnosis of VAP in the observation group was higher than thatin the control group, and the differences were statistically significant（P〈0.05）. The amount of sputum change and thechange of subglottic secretion in the observation group was significantly lower than that in the control group. The CPISof the observation group was significantly higher than that of the control group on the 7th day, and the mechanical ventilation time, ICU stay time and ICU hospitalization expenses were significantly less than those in the control group, andthe difference was statistically significant（P〈0.05）. Conclusion Conical balloon tracheal tube can significantly reducesubglottic secretion and aspiration, reduce the incidence of VAP in patients with acute myocardial infarction complicated with respiratory failure, shorten the mechanical ventilation time and reduce the ICU stay time. It is worthy of popularization in clinical practice.

关 键 词：心肌梗死 锥形气囊气管导管 机械通气 呼吸机相关肺炎 误吸 

分 类 号：R541.4[医药卫生—心血管疾病] R563.1[医药卫生—内科学]