呼吸机集束化策略依从性对ICU机械通气患者呼吸机相关性肺炎的影响

Compliance of medical staff with ventilator bundle for mechanically ventilated patients in ICU and to explore the effect on ventilator-associated pneumonia(VAP)

目的 了解ICU机械通气患者呼吸机集束化策略的临床依从性及对患者呼吸机相关性肺炎（VAP）发生率的影响,为有效预防VAP提供参考.方法 对104例ICU机械通气患者实施呼吸机集束化策略,统计患者VAP发生率、机械通气时间、ICU住院日、预后及呼吸机集束化策略临床依从性.结果 实施呼吸机集束化策略后,22例（21.15%）发生VAP.患者ICU住院日为2～44（12.22±6.04）d,好转69例,恶化11例,死亡24例.80例完全落实呼吸机集束化策略者VAP发生率15.00%,24例不完全依从者VAP发生率41.67%,呼吸机集束化策略完全依从者VAP发生率显著低于不完全依从者（P＜0.01）;预防消化性溃疡及预防深静脉血栓两项措施的临床依从性对VAP发生无影响（均P＞0.05）.结论 呼吸机集束化策略能有效预防VAP并改善患者预后,但临床依从性是影响其预防效果的显著因素,预防消化性溃疡及预防深静脉血栓这两项措施的有效性需进一步研究论证.

Objective To evaluate ICU medical staff＇s compliance with ventilator bundle for mechanically ventilated patients and the effect on ventilator-associated pneumonia（VAP）. Methods Totally, 104 mechanically ventilated patients in ICU received the ventila- tor bundle. Incidence of VAP, duration of mechanical ventilation, ICU length of stay, prognosis, and staffrs compliance with the ventilator bundle were evaluated. Results Totally, 22 （21.15%） patients developed VAP; there were 17 VAP cases per 1 000 venti- lator days. The ICU length of stay ranged 2 to 44 d, averaging （12.22±6.04）d. Sixty-nine patients began to take a turn for the better, 11 patients got worse and 24 patients were dead. Among eighty patients who had the ventilator bundle fully implemented, 15.00% developed VAP, versus 41.67% in 24 patients who had the ventilator bundle not fully implemented. The incidence of VAP in the fully implemented group was significantly lower than in the not fully implemented group （P〈0.01）. Staff＇s compliance with peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis made no impact on development of VAP（P〉0.05 for both）. Conclusion Ventilator bundle could prevent VAP and improve patients＇ prognosis effectively, and compliance significantly affects the preventive effect of the bundle. The effectiveness of peptic ulcer disease prophylaxis and deep venous thrombosis prophy- laxis needs further verification.