集束化措施精细化管理预防呼吸机相关性肺炎的临床研究

Clinical Study on Ventilator Care Bundle Fine Management in Prevention of Ventilator-associcated Peneumonia

目的 研究集束化措施精细化管理预防呼吸机相关性肺炎（VAP）的效果,探讨降低VAP发生率的方法,为临床的VAP预防提供指导.方法 选取新疆医科大学第一附属医院综合ICU 2013年1～12月符合纳入标准的129例患者作为研究对象,其中55例患者作为试验组,实行集束化措施精细化管理.另外74例患者作为对照组,实行集束化管理（VCB）.对试验组患者除了给予抬高床头30°～45°、每日唤醒计划、预防消化道溃疡、预防深静脉血栓外另给予氯己定口腔护理、声门下分泌物吸引、震动排痰.比较两组患者的VAP发生率、机械通气时间、抗生素使用时间及ICU停留时间.结果 与对照组相比,实行集束化措施精细化管理后VAP的发生率由35.1％下降至18.1％,差异有统计学意义（P＜0.05）,机械通气时间、抗生素使用时间和ICU停留时间明显缩短,且差异亦有统计学意义（P＜0.05）.结论 集束化措施精细化管理预防措施可以有效的降低VAP的发生率,并可缩短患者机械通气时间、抗生素使用时间和ICU停留时间.

Objective To analyze the effect of the ventilator care bundle fine management in prevention of ventilator - associcated peneumonia （VAP） ,explore with simple methods for reduce the incidence of VAP and provide guidance for VAP prevention in clinical. Methods A total of 129 untreated ICU cases who entered the frist affiliated hospital of xinjiang medical univercity from January 2013 to December 2013 were divided in to test and control groups randomly. Fiytyfive patients of test group were given ventilator care bundle （VCB） that including lifted the head of a bed to an angel of 30° - 45 ° , daily wake - up plan, the prevention of digestive tract ulcers, the prevention of deep venous thrombosis, meanwhile, the chlorine oral nursing care, attracting of subglottic and vibratory sputum ejection were given, calls ventilator care bundle fine management group. While 74 patients of control group were just given ventilator care bundle. The incidence of VAP, mechanical ventilation duration, antibiotic use time and ICU stay between the 2 groups were compared. Results As compared with the experiment group, the incidence of VAP decreased from 35.1% to 18.1% after ad opting the modified bundle strate- gies （P 〈 0.05 ）. There was a significant reduce in the experiment group of the duration of mechanical ventilation, antibiotic use time and ICU stay（P 〈 0.05）. Conclusion Ventilator care bundle fine management can effectively reduce the incidence of VAP and the experi- ment group of the duration of mechanical ventilation, antibiotic use time and ICU stay.