俯卧位机械通气对重症肺炎患者气道菌群分布的影响  

Effect of mechanical ventilation in prone position on airway microflora distribution in patients with severe pneumonia

作　　者：胡月红[1] 应利君[1] 周尧英[2] 王志娟[2] 孙雪东[1] HU Yue-hong;YING Li-jun;ZHOU Yao-ying;WANG Zhi-juan;SUN Xue-dong(Shaoxing People's Hospital,Shaoxing,Zhejiang 312300,China)

机构地区：[1]绍兴市人民医院重症医学科,浙江绍兴312300 [2]绍兴市人民医院护理部,浙江绍兴312300

出　　处：《中华医院感染学杂志》2022年第15期2279-2283,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技项目(2020ky328)。

摘　　要：目的分析俯卧位机械通气对重症肺部感染患者气道菌群分布的影响。方法选取2018年3月-2021年1月绍兴市人民医院重症医学科重症肺部感染者120例,随机分为研究组(俯卧位机械通气)、对照组(常规体位机械通气)各60例,比较两组入科前后血气分析、血流动力学指标,测定气道分泌物、呼吸机冷凝水中菌群情况,记录机械通气时间、呼吸机相关性肺炎(VAP)发生时间和频率、14 d气管拔管率、28 d生存率。结果研究组入科后1、4、7 d动脉氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))高于对照组(P<0.05);研究组入科后7 d革兰阳性菌检出率低于对照组,鲍曼不动杆菌、真菌检出率高于对照组(P<0.05);研究组机械通气时间较对照组缩短,发生VAP平均时间长于对照组,VAP发生率低于对照组(P<0.05),研究组14 d气管拔管率高于对照组(P<0.05)。结论俯卧位机械通气可改善重症肺部感染患者血气分析指标,并减少对气道刺激和气道分泌物菌群数量、耐药性,缩短机械通气时间,值得在临床推广实践。OBJECTIVE To analyze the effect of mechanical ventilation in prone position on airway microflora distribution in patients with severe lung infection.METHODS A total of 120 patients with severe lung infection admitted to the department of Critical Care Medicine,Shaoxing People’s Hospital from Mar 2018 to Jan 2021 were recruited,and randomly divided into the study group(mechanical ventilation in prone position)and control group(mechanical ventilation in conventional position),with 60 patients in each group.Blood gas,hemodynamic indexes,bacteria in airway secretions,ventilator condensate,mechanical ventilation time,occurrence time,frequency of ventilater-associated pneumonia(VAP),14-day tracheal extubation rate and 28-day survival rate were compared between the two groups before and after admission.RESULTS The arterial partial pressure of oxygen(PaO_(2))and oxygenation index(PaO_(2)/FiO_(2))in study group were significantly higher than those in the control group on day 1,day4 and day 7 after admission(P<0.05).On day 7 after admission,the detection rate of Gram-positive bacteria in the observation group was significantly lower than that in the control group,while the detection rates of Acinetobacter baumannii and fungi were significantly higher than those in the control group(P<0.05).The mechanical ventilation time in the study group was significantly shorter than that in the control group,while the occurrence time of VAP was significantly longer than that in the control group;and the incidence of VAP was significantly lower than that in the control group(P<0.05).The tracheal extubation rate in the study group was significantly higher than that in the control group on day 14(P<0.05).CONCLUSION Mechanical ventilation in prone position can improve blood gas indexes,reduce airway stimulation and the quantity and drug resistance of microflora in airway secretions,and shorten the mechanical ventilation time of patients with severe lung infection.

关 键 词：俯卧位机械通气 重症肺部感染 气道菌群 肺泡灌洗液 

分 类 号：R563.1[医药卫生—呼吸系统]