一次性含加热丝呼吸机管路预防呼吸机相关肺炎的临床研究

Prevention of ventilator-associated pneumonia with heating wire of breath pipeline for single use

目的探讨含加热丝呼吸管路在预防呼吸机相关性肺炎（VAP）的临床价值。方法将我院ICU收治的有创机械通气患者完全随机分为对照组（53例），研究组A（54例）和研究组B（53例）。对照组呼吸机管路不含加热导丝，研究组A在吸气径路含有加热导丝（单加热丝），研究组B在吸气和呼气径路均含有加热导丝（双加热丝）。观察并比较各组患者VAP的发生率、发生时间以及引起VAP的病原菌。结果研究组A和B患者的早发性VAP发生率[分别为5．6％（3／54）、3．8％（2／53）]均明显低于对照组[26．4％（14／53）]，差异有统计学意义（均P〈0．05）。研究组B患者的迟发性VAP发生率[9．4％（5／53）]明显低于对照组和研究组A[分别为22．6％（12／53）、24．1％（13／54）]，组间比较差异有统计学意义（P〈0．05）。研究组A和B患者VAP发生时间均较对照组延迟，组间比较差异有统计学意义（P〈0．05）；研究组B患者VAP发生时间晚于研究组A，组间比较差异有统计学意义（P〈0．05）。研究组A、B及对照组患者绿脓杆菌感染率分别为7．4％（4／54）、3．8％（2／53）及34．0％（18／53），研究组与对照组比较，差异有统计学意义（P〈0．05）。结论含加热丝呼吸管路较普通管路可以降低早发性VAP的发生率，使发生时间延迟；双加热丝较单加热丝可更为有效的延迟VAP的发生，并且降低迟发性VAP发生率；一次性加热丝呼吸管路可降低绿脓杆菌感染率。

Objective To explore the clinical value of heating wire of disposable breath pipeline for preven- ting ventilator-associated pneumonia （VAP） in mechanically ventilated patients. Methods All patients who received mechanical ventilation（MV） were randomly divided into three groups：control group, treatment group A and treatment group B. There was not a heating wire in the breath pipeline of control group. There was one heating wire in the inspiratory pipeline of group A. There were two heating wires in the inspiratory and expiratory pipelines of group B. The number of the patients who got VAP and the time of getting VAP and the pathogenic bacteria of VAP were observed and compared. Results The incidences of early VAP of group A and B were all much lower than those of control group [ 5.6% （3/54） vs 26.4% （ 14/53 ）, 3.8% （2/53） vs 26.4% （ 14/53 ）, P 〈 0.05 ]. The incidences of late VAP of group B was much lower than those of group A and control group [ 9.4% （5/53） vs 22.6% （ 12/53 ）, 9.4% （ 5/53 ） vs 24.1% （ 13/54 ）, P 〈 0.05 ]. The time of getting VAP in group A and B were all later than that in the control group （ P 〈 0.05 ）. The time of getting VAP in group B is later than group A （ P 〈 0.05 ）. The infection rate of pseudomonas aeruginosa in group A, group B and control group were 7.4% （4/54）, 3.8% （2/ 53 ） and 34.0% （ 18/53 ） （ P 〈 0.05 ）. Conclusions The use of heating wire of disposable breath pipeline has lower incidence of the early VAP and later onset of VAP than general breath pipeline. The use of twin heating wire of disposable breath pipeline has lower incidence of the delayed VAP and later onset of VAP than a single heating wire of disposable breath pipeline. The use of heating wire can reduce the infection rate of pseudomonas aeruginosa.