机械通气肠内营养患者呼吸机相关肺炎预防的加强护理

The Strengthening nNursing for Preventing the Ventilator-associated Pneumonia in Patients Treated by Enteral Nutrition Combining with Mechanical Ventilation

目的了解加强护理对机械通气肠内营养患者呼吸机相关肺炎的预防作用,进一步探讨针对该类患者的合理护理干预措施。方法选择惠州市中心人民医院神经外科因不同原因致昏迷且需行机械通气支持的危重患者80例,随机分为实验组及对照组,患者各40例,其中,实验组在机械通气期间实施鼻胃管肠内营养,对照组实施肠外营养,分别对两组患者实施有差别的护理干预措施,比较两组患者在呼吸机相关肺炎发生率方面的差异。结果实验组40例患者中并发呼吸机相关肺炎8例(8/40),对照组并发呼吸机相关肺炎6例(6/40),两组患者在呼吸机相关肺炎发生率方面的差异无统计学意义(P>0.05)。结论机械通气期间实施肠内营养是安全的,其中,增加胃管长度留置、抬高床头、间断匀速泵入营养液、监测残胃量、适时增加胃动力药物等加强护理措施对于预防该类患者呼吸机相关肺炎的发生具有肯定意义。

Objective To understand preventive effect of the strengthening nursing to the ventilator-associated pneumonia in patients treated by enteral nutrition combining with mechanical ventilation, to make further study for reasonable nursing measures. Methods 80 critically ill patients in neurosurgery department of Huizhou municipal central hospital who needed mechanical ventilation because of coma. Then all cases were randomly divided into two groups, 40 cases as experimental group, 40 cases as control group. During mechanical ventilation, using nasogastrie tube enteral nutrition in experimental group, and using parenteral nutrition in control group, then respectively using different nursing measures to tow groups. Results 8 cases were complicated with the ventilator-associated pneumonia in 40 cases experimental group （8/40）, and 6 cases were complicated with the ventilator-associated pneumonia in 40 cases control group （6/40）, there were not statistical significance in the incidence of the ventilator-associated pneumonia in tow groups （P〉0.05） . Conclusion During mechanical ventilation, using enteral nutrition is safe. Strengthening nursing measures, including increasing the length of indwelling gastric tube to experimental group, elevating the bed head, pumping nutrient solution into under discontinuous uniform motion, monitoring residual gastric content, using timely gastric motor drug, and so on, is positive significance to prevent the occurrence of the ventilator-associated pneumonia in the patients of enteral nutrition of mechanical ventilation.