间断声门下灌洗结合持续声门下吸引在经口气管插管患者预防呼吸机相关性肺炎中的作用

Effect of intermittent irrigation combined with continuous aspiration of subglottic secretion on the prevention of ventilator-associated pneumonia

目的观察经口气管插管患者应用间断声门下灌洗结合持续声门下吸引对呼吸机相关性肺炎的影响。方法对入住ICU预期机械通气(Mechanical ventilation,MV)>48h的患者60例,按经口气管插管机械通气时间顺序分为A组、B组和C组,每组20例。A组采用持续声门下吸引的方法,B组采用持续声门下吸引结合间断声门下灌洗的方法,C组采用常规吸引方法。3组患者均在MV,50h、4d、7d采用支气管镜留取下呼吸道分泌物,同步留取声门下滞留物进行细菌培养,呼吸机相关性肺炎(VAP)、声门下引流的量及引流管发生堵塞的情况进行统计和观察。结果 A组患者VAP及4d内VAP的发生率分别为38.9%、16.7%,B组为33.3%、11.1%,C组为73.7%、47.4%。B组声门下引流总量明显多于A组,B组和A组声门下引流总量明显多于C组。A组患者引流管堵塞的发生率为27.8%,C组为42.1%,B组未发生引流管堵塞的现象。结论间断声门下灌洗结合持续声门下吸引可以降低附加管堵塞的发生率,降低VAP的发生率。

Objective To evaluate the effect of intermittent irrigation combined with continuous aspiration of subglottie secretion on the prevention of ventilator-associated pneumonia（VAP）. Methods Sixty ICU patients with mechanical ventilation were divided into 3 groups,20 cases in each group. The patients in group A received continuous aspiration of subglottic secretion;the patients in group B received intermittent irrigation combined with continuous aspiration of subglottic secretion;the patients in group C received conventional treatment. The specimen of respiratory tract secretion and residual subglottic secretion were taken for bacterial culture at 50 hours,4 days and 7 days after mechanical ventilation. Moreover,the incidence of VAP,the volume of subglottic drainage and the incidence of obstruction of drainage tube were recorded. Results The total incidence of VAP and incidence of VAP at 4 days after mechanical ventilation in group A was 38.9% and 16.7%, respectively;33.3% and 11.1% in group B;73.7% and 47.4% in group C. The volume of subglottic drainage in group B was significantly higher than group A and group C. The incidence of obstruction of the drainage tube was 27.8%,42.1% and zero in group A,group C and group B,respectively. Conclusion Intermittent subglottic irrigation combined with continuous aspiration of subglottic secretion can maintain the subglottic drainage unobstructed,reduce the incidence of obstruction of drainage tube and VAP.