持续声门下吸引加间断冲洗对机械通气患者相关肺炎中的疗效分析

Clinical analysis on continuous aspiration of subglottic secretion and intermittent irrigation for patients with ventilator associated pneumonia

目的：观察持续声门下吸引对预防ICU气管切开患者呼吸机相关肺炎（VAP）中的疗效。方法：选择我科120例气管切开行机械通气的患者为研究对象，随机分为观察组和对照组各60例，其中观察组采用持续声门下吸引加间断冲洗，对照组采用间断吸引和冲洗方法。比较两组患者VAP发生率及呼吸机使用时间，声门下滞留物、声门下滞留物吸引量，细菌药敏分析及并发症发生情况。结果：4d内两组患者VAP发生率差异无统计学意义（P〉0．05）。4～10d对照组VAP发生率明显低于观察组。观察组呼吸道滞留物培养结果显示铜绿假单胞菌、大肠埃希菌对同种药物的耐药率明显低于对照组。此外，呛咳等并发症发生率均低于对照组（P〈0．05）。结论：ICU气管切开行机械通气患者进行声门下持续负压吸引加间断冲洗，可降低并发症的发生并减少细菌耐药。

Objective： To observe the efficacy of continuous aspiration of subglottic secretion in prevention of ventilator associated pneumonia（VAP） for patients after tracheotomy in ICU. Methods： 120 cases of tracheotomy for mechanical ventilation in our department were selected and randomly divided into an observation group and a control group, 60 cases in each group. Patients in the observation group were treated with continuous aspiration of subglottic secretion and intermittent irrigation, while patients in the control group were treated with intermittent aspiration and irrigation. The incidence rate of VAP, the duration of mechanical ventilation,subglottic secretion, quantity of subglottic secretion of the two groups were compared and the bacterial and drug resistance and complication conditions of the two groups were analyzed. Results： Within 4D, the incidence of VAP was no significant difference （P〉0.05）. During 4 to 10d, the incidence of VAP in the control group was obviously lower than that in the observation group. The respiratory tract secretion cultivation results showed that the resistance of Pseudomonas aeruginosa, Escherichia coli to the same medicine in the observation group was significantly lower than those in the control group. In addition, the incidence of complications such as cough was lower than that of the control group（P〈0.05）. Conclusion： The therapy of continuous aspiration of Subglottic secretion and intermittent irrigation for patients with tracheotomy for mechanical ventilation in ICU can reduce the incidence of complications and reduce bacterial resistance.