ε-聚赖氨酸预防儿科重症监护室机械通气患儿呼吸机相关性肺炎的效果研究

Clinical research of ε-polylysine in the prevention of ventilator-associated pneumonia for children with mechanical ventilation in PICU

目的：探讨ε-聚赖氨酸干预法对儿科重症监护室（ PICU）机械通气患儿呼吸机相关性肺炎（ VAP）的干预作用，为VAP的预防提供依据。方法将2012年1—9月重庆医科大学附属儿童医院PICU接受机械通气治疗的患儿90例按照机械通气时间顺序编号，采用简单随机抽样法分为A组（每天干预3次）、B组（每天干预2次）和C组（无干预）。监测患儿VAP发生率、机械通气时间与呼吸机管路不同部位细菌培养结果。结果 A、B、C组患儿VAP发生率分别为10％，30％，70％，差异有统计学意义（χ2＝24．115，P＜0．01）；3组患儿机械通气时间分别为（4．2±0．4），（5．2±0．7），（7．1±0．3）h，差异有统计学意义（F＝260．953，P＜0．01）。在第4天和第7天，3组患儿呼吸及管路的进气段冷凝水、出气段冷凝水与Y型接口处细菌培养阳性比较，差异有统计学意义（χ2＝12．115～34．658，P＜0．01）。在第4天和第5～8天，3组患儿呼吸机管路进气段和出气段冷凝水菌落数比较，差异有统计学意义（χ2＝12．604～47．624，P＜0．01）。结论每天3次28μg／ml的ε-聚赖氨酸干预能有效抑制呼吸机管路常见定植细菌的生长，切断外源性感染途径，降低VAP发生率，缩短机械通气时间，改善患儿预后。

Objective To investigate the effect of ε-polylysine to prevent ventilator-associated pneumonia （ VAP） for children with mechanical ventilation in Pediatric Intensive Care Unit （ PICU ） and to provide evidence-based procedure for clinical VAP prevention.Methods A total of ninety children with mechanical ventilation in PICU from January to September in 2012 were randomly divided into three groups averagely：experimental group A and B （3 timesε-polylysine intervention daily as group A,2 timesε-polylysine intervention daily as group B） and control group （ non-ε-polylysine-intervention as group C） .All cases had been numbered by time sequence.ε-polylysine was sprayed to Y-interface.The incidences of VAP were targeted monitored, and sampling bacteria on lower respiratory tract and various parts of ventilator tubing （ thread-inlet end and outlet end interface, condensate of inlet and outlet section, Y-type interface, wet tank） had been isolated, cultured and counted.Results The rates of VAP were 10%, 30%and 70%respectively in group A, B and C （χ2 =24.115;P〈0.01）, while the time of mechanical ventilation in three groups were （4.2 ±0.4）, （5.2 ±0.7） and （7.1 ±0.3）h （F=260.953;P〈0.01）.In the fourth day and seventh day, we compared the numbers of bacteria in children′s respiration and tube for air admission, tube for air outlet and Y-type interface indicated statistical significance （χ2 =12.115-34.658,P〈0.01）.On the fourth day and fifth to eighth day, we compared children patients′bacteria amount in condensate water for ventilator′s air inlet and outlet in three groups, it showed that they had statistical significance （χ2 =12.604 -47.624;P 〈0.01）. Conclusions The use of 28 μg/ml ε-polylysine 3 times daily can effectively control bacterial colonization in ventilator tubing, cut off infection from exogenous route, reduce the incidence of VAP, shorten mechanical ventilation time and improve the prognosis, and make more important guiding significance on clinical nursing.