改良集束化策略预防呼吸机相关性肺炎的临床研究

Clinical study on modified bundle strategies in prevention of ventilator-associated pneumonia

目的研究改良的集束化策略预防呼吸机相关性肺炎(VAP)的效果,探讨预防呼吸机相关性肺炎的方法。方法2009年1-12月(第1阶段)机械通气≥5d的患者94例,采用传统机械通气管理方法为对照组;2010年1-12月(第2阶段)115例机械通气患者为改良的集束化策略组,改良的集束化策略包括:每日唤醒计划,持续声门下吸引,早期肠内营养结合胃残留物容量测定,预防深静脉血栓形成;比较两组VAP发生率、机械通气时间及ICU住院时间及痰病原学检查结果。结果与对照组相比,采用改良的集束化策略后呼吸机相关性肺炎的发生率由35.1%降至16.5%,差异有统计学意义(P<0.01),机械通气时间由(15.4±7.2)d缩短至(12.0±6.1)d,差异有统计学意义(P<0.05),ICU住院时间由(17.6±7.4)d缩短至(13.7±6.6)d,差异有统计学意义(P<0.05)。结论改良的集束化策略能有效预防呼吸机相关性肺炎的发生。

Abstract： OBJECTIVE To analyze the effect of the modified bundle strategy in prevention of ventilator-associated pneumonia （VAP） and explore simple methods for prevention of VAP. METHODS From Jan. to Dec. 2009 （the first phase）, a total of 94 patients with mechanical ventilation more than 5 days were set as control group and applied with conventional mechanical ventilation strategy; from Jan. to Dec. 2010 （ Lhe second phase）, 115 patients who underwent modified bundle ventilation were set as study group; the modified bundle strategiesincluding daily wake-up plan, contirLuous attracting of subglottic, early determination of capacity of intestinal nutrition combined with gastric residae, and the prevention of deep venous thrombosis. The incidence of VAP, mechanical ventilation duration, ICU stay, and sputum etiology test between the 2 groups were compared.RESULTS As compared with the control group, the incidence of VAP decreased from 35. 1% to 16. 5% after adopting the modified bundle strategies （P〈0.01）, the duration of mechanical ventilation ：shortened from （15.4：k 7.2）dto（12.0-4-6. 1 ）d,（P〈0.05）, ICU stay reduced from （17.6：J：7.4）d to（13. 7J：6. 6）d ,（P〈0.05）. CONCLUSION Modified bundle strategies can effectively prevent VAP.