不同气管内吸痰方式对降低ICU患者呼吸机相关性肺炎的效果探讨

Observation of the Effect of Different Endotracheal Suctioning Ways on Reducing the Ventilator-associated Pneumonia in ICU Patients

目的评价不同气管内吸痰方式对降低ICU患者呼吸机相关性肺炎发生率的临床效果。方法选取2010年6月—2013年5月该院ICU行机械通气的患者共计84例,随机分为观察组和对照组,其中观察组42例,采用密闭式气管内吸痰,对照组42例,采用开放式气管内吸痰,观察并比较两组不同气管内吸痰方式通气后支气管肺泡灌洗液培养细菌检出率及两组患者呼吸机相关性肺炎发生率。结果观察组通气后48 h、通气后72 h及停止通气时的呼吸机相关性肺炎的发生率分别为9.52%、16.67%及21.43%,相比于对照组同时段的发生率19.05%、28.57%、35.71%差异有统计学意义(P<0.05);观察组24、48 h及停止通气时痰培养细菌检出率分别为4.76%、9.52%及23.80%,对照组24 h、48 h及停止通气时痰培养细菌检出率分别为11.90%、21.43%及38.10%,两组患者不同时间段痰液培养细菌检出率相比较差异有统计学意义(P<0.05);观察组患者总机械通气时间为(60.32±21.23)h,对照组总机械通气时间为(79.15±31.23)h,两组患者总机械通气时间相比差异有统计学意义(P<0.05)。结论针对ICU内行机械通气的患者进行密闭式气管内吸痰可有效预防呼吸机相关性肺炎的发生,减少通气时间,值得在临床上予以推广。

Objective To evaluate the clinical effect of different endotracheal suctioning ways on reducing the ventilator-associated pneumonia in ICU patients.Methods A total of 84 cases underwent mechanical ventilation in the ICU of our hospital from June 2010 to May 2013 were selected and randomly divided into the observation group and the control group. 42 cases in the observation group were given closed endotracheal suctioning, while 42 cases in the control group were given open endotracheal suctioning. And the bacteria detection rate of cultured bronchoalveolar lavage fluid and the incidence of ventilator-associated pneumonia of the two groups after endotracheal suctioning ventilation were observed and compared.Results After 48 h, 72 h of ventilation and at the time of stopping ventilation, in the observation group, the incidence of ventilation-associated pneumonia was 9.52%, 16.67%, 21.43%, respectively, and that in the control group was 19.05%, 28.57%, 35.71%, respectively, the differences between the two groups were statistically significant（P〈0.05）. After 48 h, 72 h of ventilation and at the time of stopping ventilation, in the observation group, the bacteria detection rate of cultured bronchoalveolar lavage fluid was 4.76%, 9.52%, 23.80%, respectively, and that in the control group was 11.90%, 21.43%, 38.10%, respectively, the differences between the two groups were statistically significant（P〈0.05）. The total time of ventilation in the observation group was （60.32±21.23）h, and that in the control group was （79.15±31.23）h, the difference between the two groups was statistically significant（P〈0.05）.Conclusion For patients with mechanical ventilation in the ICU, closed endotracheal suctioning can effectively prevent the incidence of ventilator-associated pneumonia and shorten the duration of ventilation, which is worthy of clinical promotion.