摘要
目的分析气管导管气囊上滞留物清除时机与呼吸机相关性肺炎(VAP)的相关性,探讨降低VAP发生率的合理气管导管气囊滞留物清除频次,以提高机械通气患者的安全性。方法选择2017年1月至2018年1月我院行机械通气治疗的患者216例,将其随机等分为A,B,C,D4组。4组均采用可冲洗式气管导管通气。A组患者每2h冲洗清除1次气囊滞留物,B组患者每4h冲洗清除1次气囊滞留物,C组患者每6h冲洗清除1次气囊滞留物,D组患者采用持续性声门下吸引气囊滞留物。比较4组患者气管插管后机械通气3,6,9d吸引物隐血试验阳性率、临床肺部感染评分(CPIS)、VAP发生率。经Spearman分析气管导管气囊滞留物清除频率与VAP间的相关性。结果4组患者机械通气3d时吸引物隐血试验阳性率、CPIS评分比较差异无统计学意义(P>0.05)。机械通气6,9d时,D组患者吸引物隐血试验阳性率高于A,B,C组(P<0.05);A,D组CPIS评分均明显低于B,C组(P<0.05),A组与D组、B组与C组间CPIS评分比较差异无统计学意义(P>0.05)。4组患者机械通气3d后VAP发生率比较差异无统计学意义(P>0.05),机械通气6,9d后,A,D组患者VAP发生率均明显低于B,C组(P<0.05),A组与D组、B组与C组间比较差异无统计学意义(P>0.05)。经Spearman分析,气管导管气囊滞留物清除频率与VAP发生率密切相关(P<0.05)。结论机械通气时采用每2h1次清除气管导管气囊上滞留物可有效降低患者并发VAP概率,且并不增加吸引物隐血试验阳性率,应加强对气囊压力控制,避免出现气道密闭问题而导致患者通气质量受影响。
Objective To analyze the correlation between the timing of retentate removal on the balloon of tracheal catheter and ventilator associated pneumonia(VAP), and to explore the reasonable frequency of retentate removal on the balloon of tracheal catheter, thus improving the safety of mechanical ventilation patients. Methods We selected 216 cases of patients who underwent mechanical ventilation in our hospital from January 2017 to January 2018 as the study subjects. They were divided into group A, group B, group C, and group D randomly with the same number of patients. All of the four groups were treated with flushable tracheal tube ventilation. Patients' balloon retentate in group A was flushed once every 2 hours. Patients' balloon retentate in group B was flushed once every 4 hours. Patients' balloon retentate in group C was flushed once every 6 hours. Patients in group D used continuous glottis to draw the balloon retentate. The positive rate of occult blood test, the incidence of clinical pulmonary infection score(CPIS)and VAP were compared among the four groups at 3 days, 6 days and 9 day after the mechanical ventilation of endotracheal intubation. Spearman analysis was used to study the correlation between the frequency of tracheal balloon remnant clearance and VAP. Results There was no significant statistical difference in the positive rate of occult blood test and CPIS score between the 4 groups of patients with mechanical ventilation for 3 days( P >0.05). At 6 and 9 days after mechanical ventilation, the positive rate of occult blood test in group D was higher than that in group A, group B and group C( P <0.05). The scores of CPIS in group A and group D were significantly lower than those in group B and C( P <0.05). There was no statistical significance in the comparative difference of CPIS scores between group A and group D, and between group B and group C( P >0.05). At 3 days after mechanical ventilation, there was no statistical significance in the comparative difference of incidence of VAP between the 4
作者
宋宏
苏丹
SONG Hong;SU Dan
出处
《护理实践与研究》
2019年第14期5-8,共4页
Nursing Practice and Research
关键词
机械通气
气管导管气囊滞留物
呼吸机相关性肺炎
相关性
滞留物清除时机
Mechanical ventilation
Retentate on balloon of tracheal catheter
Ventilator associated pneumonia
Correlation
Timing of retentate removal
