机械通气患者不同声门下吸引方式的临床对比研究

Clinical comparative study on continuous and intermittent aspiration of subglottic secretion

目的比较持续性声门下吸引（CASS）和间歇性声门下吸引（IASS）在预防呼吸机相关性肺炎（VAP）中的临床价值，及其对气道黏膜的影响。方法将ICU收治的116例机械通气患者随机分为3组：CASS组（40例）、1ASS组（38例）和对照组（不行声门下吸引，38例）。记录并比较3组患者早发性和晚发性VAP发病率、发生时间，以及CASS组、1ASS组患者气囊上方吸引液潜血阳性例数。结果①CAAA组和IASS组的早发性和晚发性VAP发病率相似，差异无统计学意义（P〉0．05）。CASS组和IASS组的早发性和晚发性VAP发病率均低于对照组（P〈0．05或P〈0．01）。②CASS组和IASS组VAP发生时间晚于对照组（P〈0．05）。CASS组和IASS组VAP发生时间相似，差异无统计学意义（P〉O．05）。③IASS组的气囊上方吸引液潜血阳性率低于CASS组（Pd0．05）。结论CASS和IASS均可降低早发性和晚发性VAP发病率，并延迟VAP的发生，两者临床效果相似。但IASS有更低的气囊上方气道黏膜损伤风险。

Objective To compare the clinical preventive effects between continuous aspiration of subglottic secretion （CASS） and intermittent aspiration of subglottic secretion （IASS） on ventilato〉 associated pneumonia （VAP）, and study the tracheal wall injury of them. Methods 116 patients, who received mechanical ventilation, were randomly divided into three groups：CASS group （40 cases）, IASS group （38 cases）, and control group （38 cases, not received aspiration of subglottic secretion）. The number of patients who got VAP, the time of getting VAP, and the positive number of occult blood of secretion upper cuff were observed. Results （DThe morbidity of early-onset VAP or late-onset VAP.. CASS group and IASS group were both much lower than control group （ P （0.05 or P （0.01）. But there was no statistical difference between CASS group and lASS group （ P 〈0.05）. （1）The time of getting VAP：CASS group and lASS group were both later than control group （ P 〈0.05）. But there was no statistical difference between CASS group and IASS group （ P 〈0.05）. （2）The positive rate of occult blood test in IASS group was lower than that in CASS group （ P 〈0.05）. Conclusions Both CASS and IASS can decrease the morbidity of early-onset and late-onset VAP. And they can delay the occurrence time of VAP. They have the same clinical effect. But the risk of tracheal wall injury in lASS is lower than that in CASS.