每日唤醒次数对呼吸机相关性肺炎发生率的影响

Influence of daily wake - up frequency on the incidence of ventilator - associated pneumonia

目的观察每日唤醒次数对呼吸机相关性肺炎发生率的影响。方法将120例全部实行有创机械通气治疗的重症监护病房的病人，分为5组；各组在常规综合治疗同时，对照组加用咪达唑仑镇静，镇静深度为Ramsay分级3—4级，实施每日早晚1-4次的唤醒计划，每次持续2小时。观察四组机械通气时间、ICU停留时间和依据预先自制定的研究方案确认的VAP发生率。结果对照组在机械通气时间、ICU停留时间、VAP发生率为：138．1±65．4；183．8±73．7；22．41（13／66）。治疗组1在机械通气时间、ICU停留时间、VAP发生率为：104．5±65．0；159．5±80．7；6．50（5／62）。治疗组2在机械通气时间、ICU停留时间、VAP发生率为：89．2±52．3；131．2±79．5；2．68（3／58）。治疗组3在机械通气时间、ICU停留时间、VAP发生率为：99±61．2；156．8±90．3；11．94（8／67）。治疗组4在机械通气时间、ICU停留时间、YAP发生率为：149±63．8；193．2±83．1；26．79（15／56）。结论每日唤2次，可明显缩短重症病人机械通气时间、ICU停留时间和VAP发生率。

Objective To observe the influence of daily wake- up frequency on the incidence of ventilator- associated pneumonia（VAP）. Methods 120 cases receiving invasive mechanical ventilation in ICU were divided into 5 groups. Routine combination therapy was given to all groups. Midazolam was given to control group in addition for sedation （grade 3 or4 on the Ramsey sedation scale）. Wake - up plan was implemented, 1 to 4 times on the morning or at night every day, each lasting 2 hours. The other four groups were observed for mechanical ventilation time, ICU stay and VAP incidence based on pre - established research programs. Results In control group, mechanical ventilation, ICU stay and VAP incidence were （ 138.1 ± 65.4）, （ 183.8 ± 73.7） and 22.41 （13/66） respectively. In treatment group1, mechanical ventilation, ICU stay and VAP incidence were （ 104. 5± 65.0）, （ 159.5 ± 80.7） and 6.50（5/62） respectively. In treatment group 2, mechanical ventilation, ICU stay and VAP incidence were （89.2 ±52.3）, （131.2± 79.5） and 2.68（3/58） respectively. In treatment group 3, mechanical ventilation, ICU stay and VAP incidence were （99 ± 61.2）, （156.8 ± 90.3） and 11.94 （8 / 67） respectively. In treatment group 4, mechanical ventilation, ICU stay and VAP incidence were （149 ± 63.8）, （193.2 ± 83.1）, and 26.79 （15/56） respectively. Conclusions Waking up the critically ill patients twice a day can significantly shorten the duration of mechanical ventilation, ICU stay and the incidence of VAP.