声门下吸引导管预防呼吸机相关性肺炎在心外ICU中的应用研究  

Application of subglottic suction catheter to prevent ventilator-associated pneumonia in cardiovascular surgery intensive care unit

作　　者：刘超[1,2] 孟树萍 刘富荣[1,2] 陈会娟 胡延磊[1,2] 曹丹丹 王磊 曹烨 王书鹏 LIU Chao;MENG Shuping;LIU Furong;CHEN Huijuan;HU Yanlei;CAO Dandan;WANG Lei;CAO Ye;WANG Shupeng(Department of Cardiovascular Surgery ICU,Heart Center of Henan People’s Hospital,Zhengzhou 450000,China;Department of Cardiovascular Surgery ICU,Central China Fuwai Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院心脏中心心血管外科重症监护室,河南郑州450000 [2]华中阜外医院心血管外科重症监护室,河南郑州450000

出　　处：《宁夏医学杂志》2022年第2期104-108,共5页Ningxia Medical Journal

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190794)。

摘　　要：目的分析声门下吸引导管预防呼吸机相关性肺炎(VAP)在心外重症监护室(SICU)中的应用效果。方法选取接受成人心外科手术的300例患者为研究对象,采用简单随机分组法分为实验组和对照组,每组各150例。2组患者均给予机械通气常规护理,实验组同时给予带气囊上吸引的气管插管,给予声门下吸引。比较2组患者各呼吸力学指标、VAP发生、机械通气和ICU住院情况、各炎性相关因子水平、各血氧指标水平和下呼吸道滞留物细菌培养结果。结果进入ICU当天2组患者的各项呼吸力学指标、炎性相关因子水平和各项血氧指标水平比较差异无统计学意义(P>0.05),转出ICU前24 h内实验组患者的气道阻力(Raw)水平、VAP发生率、机械通气时间、ICU住院时间、血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))水平均低于对照组,呼吸做功(WOB)、动态顺应性(Cdyn)、气道峰压(PIP)、VAP发生时间、血氧饱和度水平高于对照组,差异有统计学意义(P<0.05)。实验组与对照组患者下呼吸道滞留物细菌培养均以铜绿假单胞菌、肺炎克雷伯菌为主,2组比较差异无统计学意义(P>0.05)。结论应用声门下吸引导管可以改善心外科手术患者术后ICU内呼吸功能,缓解炎性反应,稳定血氧变化,缩短机械通气时间和ICU住院时间,降低VAP发生率。Objective To analyze the application effect of subglottic suction catheter to prevent ventilator-associated pneumonia(VAP)in cardiovascular surgery intensive care unit(SICU).Methods A total of 300 patients who underwent adult cardiac surgery were selected as the research subjects.It was divided into experimental group and control group with the help of Excel table by simple random grouping method,each with 150 cases.Patients in the two groups were given routine care for mechanical ventilation.The experimental group was given a tracheal intubation with a balloon upper suction and a subglottic suction at the same time.The respiratory mechanics indexes,VAP occurrence,mechanical ventilation and ICU hospitalization,the levels of various inflammatory factors,the levels of blood oxygen indexes and the results of bacterial culture of lower respiratory tract retentate were compared between the two groups.Results There was no significant difference in the levels of respiratory mechanics,inflammatory factors,and blood oxygen levels between the two groups of patients on the day of entering the ICU(P>0.05).The airway resistance of the experimental group was within 24 hours before being transferred to the ICU.(Raw)level,incidence of VAP,duration of mechanical ventilation,length of stay in ICU,serum C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)level,arterial blood oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))levels are lower than the control group,work of breathing(WOB),dynamic compliance(Cdyn),peak airway pressure(PIP),the onset time of VAP,and blood oxygen saturation levels were higher than those of the control group,and the differences were significant(P<0.05).The bacterial culture of the lower respiratory tract retentate of the experimental group and the control group were mainly Pseudomonas aeruginosa and Klebsiella pneumoniae,and there was no significant difference between the two groups(P>0.05).Conclusion Subglottic aspiration cathet

关 键 词：心外科手术 呼吸机相关性肺炎 心外重症监护室 声门下吸引导管 

分 类 号：R563.1[医药卫生—呼吸系统]