摘要
目的 探讨不同间隔时间冲洗吸引气管导管气囊上滞留物对呼吸机相关性肺炎（VAP）的影响.方法 选取收治于重症监护病房且气管插管行机械通气治疗的患者150例,按插管时间的先后分成A、B、C3组,分别于间隔2、4、6 h对气囊上滞留物进行冲洗吸引.比较3组在插管即时及插管后3、5、7 d的气囊上滞留物隐血试验情况、气囊上滞留物含菌量、VAP的发生数及VAP发生时间方面的差异.结果 气囊上滞留物隐血试验比较,A组阳性78例、B组46例、C组38例,3组比较差异有统计学意义（χ^2=28.23,P=0.00）;3组含菌量比较差异有统计学意义（Z=11.91,P=0.00）,其中A组与C组（Z=-3.01,P=0.00）、B组与C组（Z=-2.19,P=0.01）差异有统计学意义.VAP的发生例数比较,A组发生12例、B组13例、C组23例,3组比较差异有统计学意义（χ^2=7.50,P=0.00）,A组与C组（χ^2=5.32,P=0.02）、B组与C组比较（χ^2=4.34,P=0.04）差异有统计学意义.VAP的发生时间A组（169.25 ± 20.80）h、B组（168.35 ± 18.04）h、C组（129.47 ± 18.13）h,3组比较差异有统计学意义（F=2788.19,P=0.00）,A组与C组（t=3.19,P=0.00）、B组与C组（t=68.40,P=0.00）差异有统计学意义.结论 间隔4h对气囊上滞留物进行冲洗吸引不但对气道黏膜的损伤较小,还可以降低气道含菌量及VAP的发生率,延迟VAP的发生.
Objective To investigate the effects of subglottic secretion drainage at different intervals on ventilator- associated pneumonia（VAP）. Methods A total of 150 patients receiving tracheostomy during January 2015 to December 2016 were divided into A, B, C group according to the order of intubation time. The subglottic secretion drainage was attracted at intervals of 2, 4, and 6 h respectively.The differences in balloon secretion on occult blood test（after intubation,intubation time,3 d, 5 d,7 d）, the content of airborne bacteria in the air sac, the number of VAP and the time of VAP occurrence between the 3 groups were analyzed. Results The 3 groups that group A had 78 positive cases,group B had 46 cases and group C had 38 cases had statistical significance differences compared with balloon retentate occult blood test（χ^2=28.23,P=0.00）;there were statistical significance differences between the 3 groups of bacteria （Z=11.91, P =0.00 ）, there were statistically significant differences between group A and group C （Z=-3.01, P=0.00）, between group B and group C （Z=-2.19, P=0.01）. There were statistical significance differences between the 3 groups of the number of VAP cases（χ^2=7.50, P =0.00） that there were 12 cases happening in group A, 13 cases in group B and 23 cases in group C. There were statistical significance differences between group A and group C（χ^2=5.32,P=0.02）,between group B and group C （χ^2=4.34, P =0.04）. The occurrence time of VAP which was （169.25 ± 20.80） h in group A,（168.35±18.04）h in group B and（129.47±18.13）h in group C,there was significantly different between the 3 groups（F=2 788.19,P=0.00）,the differences between group A and group C（t=3.19,P=0.00）,group B and group C（t=68.40,P=0.00）were statistically significant. Conclusions The subglottic secretion drainage at intervals of 4 hours will not only reduce the damage to the airway mucosa,but also reduce the incidence of airway bacteria and the incidence of VAP and delay the occurren
出处
《中国实用护理杂志》
2017年第29期2280-2283,共4页
Chinese Journal of Practical Nursing
关键词
通气机
机械
肺炎
呼吸机相关性
气囊上滞留物
Mechanical, mechanical
Pneumonia, ventilator-associated
Subglottic secretion
