摘要
目的探讨呼吸机集束化治疗（Bundle）临床实施的依从性以及对呼吸机相关性肺炎（VAP）的预防作用。方法采用单中心前后对照研究。将呼吸机Bundle实施前1年（对照组）以及实施后2年（干预组）本院重症监护病房（ICU）收治的18-80岁、机械通气时间≥48h的患者纳入本研究。观察干预组患者呼吸机Bundle治疗的达标率，以及两组患者的VAP发生率、机械通气时间和28d病死率。结果本研究中共入选患者237例，对照组71例，干预组166例。两组患者间性别、年龄、疾病种类以及急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分差异无统计学意义（P均〉0．05）；机械通气时间[对照组（5．9±5．6）d，干预组（5．2±6．1）d]、VAP发生率（对照组21．1％，干预组20．5％）以及28d病死率（对照组16．9%，干预组19．8％）均未发生显著改变。干预组34．3％（57／166）的患者全部达到呼吸机Bundle 4项治疗目标要求；机械通气≤3d、4～7d、〉7d患者的达标率分别为62．5％（35／56）、22．1％（21／95）、6．7％（1／15）。在Bundle4项内容中，床头抬高≥30。达标率最差，为43．4％（72／166）；每日唤醒加脱机试验、预防消化性溃疡及深静脉血栓形成3项措施的达标率相对较好[分别为92．2％（153／166）、88．0％（146／166）、83．1％（138／166）]。结论呼吸机Bundle较差的临床依从性是影响其有效性的重要因素。
Objective To investigate the compliance of ventilator bundle implementation and its preventive effect on ventilator associated pneumonia （VAP）. Methods A before and after design was used in this single center study. Patients aged from 18 to 80 years, with mechanical ventilation （MV） duration over 48 hours were recruited during 1 year before （control group） and 2 years after bundle implementation （intervention group）. Measurements included the rate of successful ventilator bundle implementation in intervention group, incidence of VAP, duration of MV and mortality within 28 days in both groups. Results A total number of 237 patients, including 71 patients in control arm and 166 patients in intervention arm, were recruited in this study. There was no statistical significance in ratio of sex, mean age, category of diseases or mean acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score between two groups （all P〉0. 05）. Significant changes were not found in MV duration [（5.9±5.6） days vs. （5.2±6.1） days], incidence of VAP （21.1% vs. 20. 5%） and mortality within 28 days （16.9% vs. 19.8%） between control and intervention group as well. In intervention group, 57 of 166 （34.3%） patients were successfully implemented all of four ventilator bundle items. The successful rate of ventilator bundle implementation were 62.5% （35/56）, 22.1% （21/95） and 6.7% （1/15） in patients received MV duration ≤3 days, 4 7 days and 〉7 days respectively. Among the four items of the bundle, head of bed elevation ≥30°had the lowest successful rate [43.4% （72/166）]. But it was much better in the implementation of daily wake-up plus weaning, prevention of peptic ulcer and prevention of deep vein thrombosis formation [92.2% （153/166）, 88.0% （146/166） and 83.1% （138/166） respectively]. Conclusion The poor compliance of ventilator bundle is an important factor in impacting the efficacy of ventilator bundle.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2009年第11期660-663,共4页
Chinese Critical Care Medicine
