呼吸机管道更换时间对 COPD 患者呼吸机相关性肺炎的影响

Effect of ventilator tube replacement time on COPD patients with ventilator-associ-ated pneumonia

目的：探讨呼吸机管道更换时间与COPD患者呼吸机相关性肺炎（ VAP ）的相关性，总结呼吸机管道更换维护方法，抑制肺炎并发。方法选取2011年4月至2013年2月我院呼吸内科收治的COPD住院患者共90例，随机分为对照组1、对照组2、实验组各30例，管道更换频率分别为1 d／次、2 d／次、4 d／次，统计并发VAP例次与时间、死亡例次和病原菌检验结果。结果对照组1并发VAP 1次、2次、3次率与死亡率分别为63．33％、30．00％、6．67％和16．67％，对照组2为60．00％、33．33％和13．33％、13．33％，实验组为60．00％和13．33％、0．00％、13．33％，实验组与对照组1和对照组2并发1次VAP、死亡率差异不显著（P＞0．05），但多次并发VAP例数少于对照组1、对照组2，差异显著（P ＜0．05）；G－杆菌是VAP感染主要菌种，G＋球菌其次，不同例次VAP病原菌菌种差异不显著（ P＞0．05）；对照组1并发第1次VAP时间短于对照组2、实验组，实验组并发第2次VAP时间长于对照组1、对照组2，对照组2并发第3次VAP时间长于对照组1，差异显著（ P＜0．05）。结论呼吸机管道更换越频繁，并发多次VAP的概率越高，但并不影响并发1次VAP概率与死亡率，对照组1并发VAP的时间相对更短，因此出于抑制多次并发考虑，可适当延长初次更换时间，并发VAP后可延长气道更换时间。

Objective To investigate the correlation of ventilator tube replacement time with COPD patients with ventilator-associ-ated pneumonia （ VAP） , summarize ventilator tube replacement maintenance methods, inhibit pneumonia.Methods April 2011-February 2013 admitted to hospital Respiratory Medicine 90 COPD patients were randomly divided into control 1 group, control 2 group, and experi-mental group, 30 patients in each group, pipe replacement frequencies were 1 d/times, 2 d/times, 4 d/times, time and concurrent VAP ca-ses, cases of death, pathogen test results were compared.Results In control 1 group, a concurrent VAP once, twice, three times and mor-tality rates were 63.33%, 30.00%, 6.67% and 16.67% respectivley, in control 2 group, were 60.00%, 33.33%, 13.33% and 13.33%respectivley, in the experimental group were 60.00%, 13.00%, 0.00% and 13.33% respectively.There were no significant differences in once concurrent VAP and mortality rate between the experimental group and control 1, 2 groups.Cases with more times con-current VAP in experimental group were significantly less than those of control 1 and 2 groups （P〈0.05）.G-bacilli VAP infection was the major species, G＋cocci was the second species.There was no significant difference in kind of pathogenic bacteria among different cases of VAP （ P〉0.05） .The first time of complicated with VAP in control 1 group was shorter than that of control 2 group and experimental group, the second time of complicated with VAP in experimental group was longer than that of control 1, 2 groups, the third time of of complicated with VAP in control 2 group was longer than that of control 1 group （P〈0.05） .Conclusion More frequently the replacement of the venti-lator tube, the higher the probability of VAP multiple concurrent, but which does not affect the probability of concurrent 1 time VAP and mortality.Time of complicated with VAP in the control 1 group is relatively shorter, so for multiple concurrent inhibition consider, first re-placement time may be extended, the airway may be extended after concurrent VAP replacement time.