双伺服性加温控制型呼吸湿化器的应用对呼吸道与呼吸机回路细菌定植的影响

Influence of application of dual servo heated control respiratory humidifier on bacterial colonization in airway and ventilator circuits

[目的]分析双伺服性加温控制型呼吸湿化器对呼吸道与呼吸机管道细菌定植的影响,为规范呼吸机管道更换周期、预防呼吸机相关性肺炎提供参考。[方法]选择重症医学科建立人工气道机械通气72h以上106例病人,使用伺服性加温控制型呼吸湿化器,分别于建立人工气道上机当天及应用第3天、第7天、第10天、第14天、第21天、第28天采样,采样部位分别为病人的咽喉部、下呼吸道、呼吸机接头端、呼吸机管道吸气端、呼吸机管道呼气端、湿化罐湿化液;对采样标本进行细菌培养,分离致病菌,比较不同时间段、不同部位致病菌的阳性率、定植率。[结果]呼吸机管道的定植菌与呼吸道病原菌具有同源性;呼吸道相同部位不同采样时间的致病菌检出率差异有统计学意义(P<0.05),呼吸机管道相同部位不同采样时间的致病菌检出率差异无统计学意义(P>0.05)。[结论]延长使用双伺服性加温控制型呼吸湿化器至28d,呼吸道细菌随着机械通气时间的延长细菌定植增加,而呼吸机管道系统随机械通气时间的增加细菌定植无明显增加;使用双伺服性加温控制型呼吸湿化器无污染的情况下持续使用是安全的,对长期使用呼吸机的病人呼吸机管道无需常规更换,对有污染或故障的呼吸机管道应及时更换。

Objective：To analyze the influence of dual servo heated control respiratory humidifier on airway and ventilator circuits bacterial colonization,and to provide references for standardizing the replacement cycle of ventilator tube and preventing ventilator associated pneumonia.Methods：A total of 106 patients with artificial airway undergoing mechanical ventilation over 72 hours were selected in ICU.All patients used dual servo heat-ed control respiratory humidifier.Sputum were collected immediately on the day of establishment of artificial airways,and on day 3,day 7,day 10,day 14,day 21,day 28.Sampling sites were patient’s pharyngeal larynx, lower respiratory tract,ventilator connector end,ventilator tube suction side,end expiratory ventilator tube and wet fluid in humidifier tank.Bacteria culture,the number of colonies and pathogens separated were carried out for sample specimens.Then to compare the positive rate and colonization rate of pathogenic bacteria at different time and in different positions.Results：Colonization of ventilator tube has homology with respiratory patho-gens.Respiratory pathogens detection rate among different parts at the same sampling time was statistically sig-nificant（P 0.05）.Conclusion：The dual servo heated control respiratory humidifier was used up to 28 days.Respiratory bacteria colonization increases with mechanical ventilation time prolonged.And the colonization in ventilator tube system didn’t significantly increase with the increase of duration of mechani-cal ventilation.Continued use of a dual servo heated control respiratory humidifier without pollution situation is safe.For long term ventilator patients without conventional ventilator tube replacement for pollution or faulty ventilator tube should be replaced.