呼吸机管路更换频率对呼吸机相关肺炎发病率的影响

The effect of ventilator circuit change frequency on ventilator-associated pneumonia incidence.

目的探讨呼吸机管路更换频率对呼吸机相关肺炎（VAP）发病率的影响。方法选择2008年3月至2010年9月入住我院综合性ICU、急诊科、呼吸内科、神经外科机械通气患者，随机分为呼吸机管路每周更换2次组与呼吸机管路每周更换1次组；目标性监测记录使用呼吸机患者的临床症状和体征变化；采集不同部位微生物标本送检，并进行统计学分析。结果呼吸机管路每周更换2次组VAP的发生率为28．30％（15／53），每周更换1次组为35．84％（19／53），组间比较差异无统计学意义（P=0．533）；呼吸机管路每周更换2次组呼吸机管路病原微生物检出率为44．49％（271／609），每周更换1次组为48．16％（289／600），组间比较差异无统计学意义（P〉0．05）；组间呼吸机管路不同部位病原微生物检出情况比较，差异无统计学意义（P〉0．05）；VAP的病原微生物以革兰阴性菌为主，鲍曼不动杆菌检出占首位。结论呼吸机管路更换频率不影响VAP的发病率，建议使用中的呼吸机管路每7天更换1次；同时应加强护理人员专科技术培训，从多环节降低医院感染的发生率。

Objective To explore the effect of ventilator circuit change frequency on the incidence of ventilator-associated pneumonia （VAP）. Methods Patients receiving mechanical ventilation in the ICU, Department of Emergency, Respiratory Department and Department of Neurosurgery from March 2008 to September 2010 were randomized into two groups. For these two groups, the ventilator circuit was changed once or twice a week. The recorded parameters included the clinical symptoms and signs of the ventilated patients. Samples at different parts of the circuit were collected for microbiological detection. The data were analyzed statistically. Results The incidence of VAP was 28.30% （13/53） in twice-a-week group and 35.84% （ 19/53 ） in once-a-week group. There was no significant difference between the two groups. The rates for positive microbiological detection in the circuit were 48.16% and 44. 49% for once-a-week and twice-a-week group, respectively. No significant difference was observed（ P 〉 0. 05 ）. Moreover, there was no significant difference in terms of the microbiology positivity between different parts of the circuit（ P 〉 0. 05 ）. Gram-negative bacteria were the main pathogen of VAP with Acinetobacter baumannii ranking at the top. Conclusion Frequency of Ventilator circuit change does not influence the incidence of VAP. We suggest that the frequency for ventilator circuit change should be once a week. At the same time, the nurse staff should be trained for specific technology and the incidence of hospital infection should be controlled at multiple rings of the chain.