非床头抬高干预策略对预防呼吸机相关性肺炎的作用

Horizontal bed head intervention strategies for the prevention of ventilator - associated pneumonia

目的探讨非床头抬高干预策略对预防呼吸机相关性肺炎（VAP）的影响。方法选取ICU行有创机械通气且不能采取床头抬高干预措施的患者80例，随机分为A组（40例）和B组（40例），A组采取常规干预策略，B组在A组基础上保持呼吸机管路低位使管路中的冷凝液不能积存在延长管而倒流人气道、持续声门下吸引、持续套管内注入湿化液和每4h洗必泰口腔冲洗等。28d内观察并记录两组VAP发生率、机械通气时间、ICU住院时间。两组患者确诊VAP患者当天（0）、3、5、10d检测临床肺部感染评分（cPis）、APACHEⅡ评分并进行比较。结果B组VAP发病率、机械通气时间、ICU住院时间均较A组低（P〈0．05），B组确诊VAP后3、5、10dCPIS评分较A组低（P〈0．05）。结论非床头抬高干预策略可降低VAP发生率，减轻VAP严重程度，一定程度改善预后。

Objective To study the role of horizontal bed head intervention strategies for the prevention of ventilator - associated pneumonia （VAP）. Methods Eighty cases with invasive mechanical ventilation can not be access to bedside up intervention in intensive care unit （ICU） were randomized to group A and group B. Group A was given conventional prevention method, and group B was given prevention method of keeping ventilator tubing in low - order, so condensate in ventilator tubing can not be poured into the airway. Continuous aspiration of subglottic secretions, sustained wet fluid injection and Chlorhexidine oral washing every 4 hours and other intervention strategies were administered to the patients in group B. 28 days after treatment, incidence of VAP, duration of mechanical ventilation, duration of stay in the ICU. 0, 3, 5, I0 - day clinical pulmonary infection score （CPIS） and APACHE 11 were respectively recorded, while patients were confirmed of VAP. Results Eighty cases with invasive mechanical ventilation can not be access to bedside up intervention in ICU were randomized to group A and group B. Group A was given conventional prevention method, and group B was given prevention method of keeping ventilator tubing in low - order, so condensate in ventilator tubing can not be poured into the airway. Continuous aspiration of subglottic secretions, sustained wet fluid injection and Chlorhexidine oral washing every 4 hours and other intervention strategies were administered to the patients in group B. 28 days after treatment, incidence of VAP, duration of mechanical ventilation, duration of stay in the ICU. O, 3, 5, 10 - day CPIS and APACHE II were respectively recorded, while patients were confirmed of VAP. Conclusion Horizontal bed head intervention strategies can reduce the incidence of VAP, and improve the condition and prognosis.