集束化治疗颅脑疾病呼吸机相关性肺炎的临床观察

A clinical observation on Bundle therapy for treatment of ventilator-associated pneumonia of craniocerebral disease

目的 探讨集柬化（Bundle）治疗对重症监护病房（ICU）重型颅脑疾病患者呼吸机相关性肺炎（VAP）的临床疗效.方法 采用前瞻性随机对照试验,选择2009年3月1日至2011年7月1日入住ICU的颅脑疾病患者1 492例,最终诊断为VAP的患者57例,按随机数字表法分为Bundle治疗组（试验组,31例）和常规治疗组（对照组,26例）.比较两组入住ICU的好转率、病死率、住ICU时间以及费用.结果 两组在年龄、性别、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、前降钙素原、诊断、合并症以及人工气道情况方面差异无统计学意义（均P＞ 0.05）.试验组好转率较对照组明显升高（90.3％比65.4％,P=0.027）,病死率较对照组明显降低（6.5％比30.8％,P=0.032）,住ICU时间（d）明显少于对照组（12.16±5.14比16.54±4.80,P-- 0.002）,入住ICU期间的总费用（万元）较对照组明显减少（6.09±2.53比7.30±1.81,P=0.046）.结论 Bundle治疗能明显提高重型颅脑疾病VAP患者的好转率,降低病死率,减少其入住ICU时间及住ICU期间的治疗费用.

Objective To study the clinical effect of Bundle therapy for treatment of ventilator-associated pneumonia （VAP） of patients with severe craniocerehral disease in the intensive care unit （ICU）. Methods A prospective randomized controlled clinical trial was carried out. One thousand four hundred and ninety-two patients with craniocerebral disease in the ICU of the Affiliated Hospital from March 1st, 2009 to July 1st, 2011 were observed and treated. Fifty-seven cases who were clinically diagnosed VAP after 48 hours were divided into Bundle therapy group （experiment group, 31 cases） and general therapy group （control group, 26 cases）. The improvement rate, mortality rate, length of stay （LOS） and the cost in ICU were compared between the two groups. Results No statistic significant differences between the experiment group and the control group in age, sex, the acute physiology and chronic health evaluation II （APACHE II ） scores, procalcitonin, diagnosis of VAP, complications and artificial airways situation were seen （all P 〉 0.05）. Compared with control group, in the experiment group, the improvement rate was markedly increased （90.3% vs. 65.4%, P = 0.027）, the mortality rate was evidently decreased （6.5% vs. 30.8%, P = 0.032）, LOS （days： 12.16 ± 5.14 vs. 16.54 ± 4.80, P = 0.002） and the medical cost were reduced significantly （thousand yuan） in ICU（60.9 ± 25.3 vs. 73.0 ± 18.1, P = 0.046）. Conclusion Bundle therapy for treatment of patients with VAP and severe craniocerebral disease can obviously increase the improvement rate, decrease the mortality rate, and reduce the LOS and cost in the ICU.