密闭吸引连接管使用时间对ICU患者VAP发生的影响  

Effect of use time of closed suction connecting tube on ventilator-associated pneumonia in ICU patients

作　　者：吴碎秋[1] 项飞[1] 陈雪丹[1] Wu Suiqiu;Xiang Fei;Chen Xuedan(Emergency Intensive Care Unit,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院急诊ICU,浙江温州325027

出　　处：《中国中西医结合急救杂志》2021年第6期676-678,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：温州市科技局项目(Y20180379)。

摘　　要：目的探讨密闭吸引连接管使用时间对重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)发生的影响。方法选择2019年12月至2020年12月温州医科大学附属第二医院急诊ICU气管切开或气管插管患者作为研究对象。纳入126例患者,根据密闭吸引连接管更换频率分为A组(更换频率:1次/24 h)40例、B组(更换频率:1次/72 h)44例、C组(更换频率:1次/120 h)42例。记录并比较治疗期间3组患者的VAP发生率。分别于机械通气24、72、120 h采集C组患者吸引连接管头端内口表面样本和痰样本,比较不同时间段吸引连接管头端和痰样本菌属类别培养情况、细菌菌落数量,对比患者的痰培养结果。结果A组VAP发生率为2.50%(1/40),B组为4.55%(2/44),C组为11.90%(5/42),3组比较差异均无统计学意义(均P>0.05)。24、72、120 h不同时间段连接管头的菌属种类和菌落数量培养结果相当〔菌属种类(种):1(1,2)、1(1,2)、2(1,3),菌落数(CFU/cm2):1000(100,4700)、1200(100,3500)、1500(100,5300),均P>0.05〕。不同时间段吸引连接管样本的细菌培养阳性率(分别为78%、80%、81%)和痰的细菌培养结果一致性(分别为50%、52%、55%)比较差异均无统计学意义(均P>0.05)。结论只要在吸痰过程中严格按照规范进行操作,连接管头端内口的细菌定植不会随着使用时间增加而增加,不会增加患者VAP发生率。Objective To explore the influence of the use time of the closed suction connecting tube on the occurrence of ventilator-associated pneumonia(VAP)in intensive care unit(ICU)patients.Methods The patients with tracheotomy or intubation in the emergency ICU of the Second Affiliated Hospital of Wenzhou Medical University from December 2019 to December 2020 were selected as the research objects.A total of 126 patients were enrolled,according to the frequency of replacement of the closed suction connecting tube,they were divided into 40 cases in group A(replacement frequency:1 time/24 hours),44 cases in group B(replacement frequency:1 time/72 hours),and 42 cases in group C(replacement frequency:1 time/120 hours).The incidence of VAP in the three groups of patients was recorded and compared during treatment.Collected the surface samples of the inner mouth of the suction connecting tube and the sputum samples from the patients in group C at 24 hours,72 hours,and 120 hours of mechanical ventilation.The genus culture and the number of bacterial colonies of the suction connecting tube,and the sputum samples in different periods were compared,The sputum culture results of the patients were compared.Results The incidence of VAP was 2.50%(1/40)in group A,4.55%(2/44)in group B and 11.90%(5/42)in group C,and there was no significant difference among the 3 groups.In 24 hours,72 hours and 120 hours,the species and colony number of the connecting tube were similar[species:1(1,2),1(1,2),2(1,3),colony number(CFU/cm2):1000(100,4700),1200(100,3500),1500(100,5300),both P>0.05].There was no significant difference in the positive rate of bacterial culture(78%,80%,81%,respectively)and the consistency of sputum cultures(50%,52%,55%,respectively),all P>0.05.Conclusions As long as the operation is carried out strictly following the specifications during the suction process,the bacterial colonization of the inner mouth of the end of the connecting tube will not increase with the prolong of the use time,and will not increase the incidence of VA

关 键 词：重症监护病房 密闭式吸引 连接管污染 

分 类 号：R47[医药卫生—护理学]