两种气囊测压法预防机械通气患者呼吸机相关性肺炎效果比较  

Effect comparison of two airway pressure measurement methods on preventing ventilator-associated pneumonia in mechanically ventilated patients

作　　者：招春园 黄玲[1] 卡沙木姐 熊晨仪 邓小娥 林景 Zhao Chunyuan;Huang Ling;Ka Shamujie;Xiong Chenyi;Deng Xiao′e;Lin Jing(Intensive Care Unit,Cancer Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院重症医学科,广西南宁530021 [2]广西医科大学附属肿瘤医院护理部,广西南宁530021

出　　处：《护理学杂志》2023年第21期62-66,共5页Journal of Nursing Science

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2018095)。

摘　　要：目的比较持续测压与间断测压对预防机械通气患者呼吸机相关性肺炎的临床效果,为人工气道气囊管理提供依据。方法将134例机械通气患者随机均分为间断测压组和持续测压组。间断测压组使用气囊测压表采用改进方法分别间隔4 h、6 h、8 h监测1次气囊压力;持续测压组采用持续测压仪持续测压。比较两组呼吸机相关性肺炎发生率、机械通气时间、ICU住院时间、气囊上滞留物引流量、抗生素使用种类及时间、炎性指标。结果两组呼吸机相关性肺炎发生率、机械通气时间、ICU住院时间、抗生素使用种类及时间比较,差异无统计学意义(均P>0.05)。两组入科第1天、第3天、第7天白细胞、C反应蛋白、降钙素原及24 h气囊上滞留物引流量比较,差异无统计学意义(均P>0.05)。持续测压组检测值25~30 cmH 2O;间断测压组间隔4 h、6 h、8 h检测气囊压力,差异有统计学意义(P<0.05),间隔8 h检测气囊压力<25 cmH 2O。结论两种测压方法对患者呼吸机相关性肺炎发生率、机械通气时间、ICU住院时间、抗生素应用的影响没有显著差异,提示锥形气囊导管应用两种测压方法可达到相同的临床效果,间断测压间隔时间以≤6 h为宜。Objective To compare the clinical effect of continuous and intermittent airway pressure measurement on preventing Ventilator-associated Pneumonia(VAP)in mechanically ventilated patients,to provide a reference for artificial airway cuff management.Methods A total of 134 patients undergoing mechanical ventilation were averagely randomized into a continuous airway pressure measurement group and an intermittent airway pressure measurement group.The cuff pressure of the intermittent group was monitored by using an airbag pressure gauge with intervals of 4 hours,6 hours,and 8 hours,while the continuous group was measured continuously by utilizing a continuous pressure gauge.The incidence of VAP,duration of mechanical ventilation,length of ICU stay,subglottic secretion drainage,types and duration of antibiotic use,and inflammatory markers during hospitalization were compared between the two groups.Results There weren′t significant differences between the two groups in the incidence of VAP,duration of mechanical ventilation,length of ICU stay,types and duration of antibiotic use(all P>0.05).There weren′t significant differences in white blood cell count,C-reactive protein,procalcitonin,and 24-hour subglottic secretion between the two groups on the 1st,3rd,and 7th day of admission(all P>0.05).In the continuous pressure measurement group,the cuff pressure was 25 to 30 cmH 2O;in the intermittent pressure measurement group,when it was measured at intervals of 4 hours,6 hours,and 8 hours,there was significant difference in the cuff pressure(P<0.05),and which was less than 25 cmH 2O when it was mea-sured with an interval of 8 hours.Conclusion There aren′t significant differences in the incidence of VAP,duration of mechanical ventilation,length of ICU stay,types and antibiotic use when the cuff pressure measured conti-nuously or intermittently in mechanically ventilated patients.It suggests that using tapered cuffs with both pressure measurement methods can achieve similar cli-nical effects,when using the intermittent pre

关 键 词：气管插管 机械通气 锥形气囊 气囊测压法 测压间隔时间 呼吸机相关性肺炎 炎性指标 气囊上滞留物 

分 类 号：R472[医药卫生—护理学]