封闭式吸痰在新生儿呼吸窘迫综合征中的应用价值

The impact of closed endotracheal suction on newborns with respiratory distress syndrome

目的探讨封闭式吸痰能否降低新生儿呼吸窘迫综合征(RDS)患儿呼吸机相关性肺炎(VAP)的发生率和住院费用。方法选择2012年1月至2013年12月收入本院新生儿重症监护病房、需要机械通气的RDS患儿,采用配对队列研究,分为观察组和对照组。观察组使用封闭式吸痰管,对照组使用开放式吸痰管,由护士对两组患儿进行吸痰操作,比较两组平均每次吸痰操作时间、VAP发生率,平均机械通气时间、吸痰管费用、住院时间、住院费用和病死率。结果两组患儿各103例,基础疾病一致,观察组平均每次吸痰操作时间短于对照组[(164.2±7.0)s比(227.2±8.4)s],VAP发生率低于对照组(10.7%比16.5%),平均机械通气时间短于对照组[(112.1±40.7)h比(148.1±46.3)h],经人工气道吸痰费用高于对照组[(464.1±28.1)元比(118.0±16.0)元],最终平均住院费用低于对照组[(32 102.1±2595.0)元比(35 174.0±3853.1)元],差异均有统计学意义(P<0.05)。两组患儿病死率差异无统计学意义(6.8%比7.8%,P>0.05)。结论封闭式吸痰较开放式吸痰可有效降低RDS患儿VAP发生率,缩短机械通气时间和住院时间,从而降低总的住院医疗费用,值得推广使用。

Objective To assess the incidence of ventilator associated pneumonia （VAP） and the cost of hospitalization with closed endotracheal suctioning on newborns with respiratory distress syndrome （RDS）. Methods A total of 206 neonates with RDS supported by ventilation were enrolled in this cohort study from January 2012 to December 2013 in the Second affiliated Hospital ＆ Yuying Children Hospital of Wenzhou Medical University. All the subjects were randomly divided into experimental group and control group. Closed endotracheal suctioning system was applied in the experimental group and the opened mode was applied in the control group. Comparisons were made of： suction times, incidence of ventilator associated pneumonia （ VAP）, duration of ventilation, mortality, the cost of suction, hospital stay and hospitalization expense. Results The baseline was not significantly different between the two groups. The average time of each suction of the experimental group was shorter than the control group [ （164. 2 ± 7.0）s vs. （227.2 ± 8.4）s,t = -84. 393, P 〈 0. 01 ]. VAP incidencewas lower in the experimental group （ 10.7% vs. 16. 5% , ,X^2= 4. 610, P 〈 0.05） . Duration of ventilation was lower in the experimental group [ （ 112. 1 ± 40. 7 ） h vs. （ 148. 1 ± 46. 3 ） h, t = - 5.926, P 〈 0. 05 ]. The cost of suction was higher in the experimental group [ （464. 1 ± 28.1 ） RMB vs. （ 118.0 ± 16.0） RMB ,t = 57. 160, P 〈0. 01 ], but the hospitalization expense was lower in the experimental group [（32102.1±2595.0）RMB vs. （35 174.0 ±3853.1）RMB,t = -7.140,P〈0.05]. There was no significant difference in mortality between the two groups （ 6. 8% vs. 7.8% ,X^2 = 0. 08, P 〉 0. 05 ）. Conclusions The application of closed endotracheal suction system, compared with open mode, resulted in decreased incidence of VAP and shortened duration of ventilation and hospitalization, which reduced the expense of hospitalization in neonates with RDS.