综合性干预措施对新生儿呼吸机相关性肺炎的影响

The influence of comprehensive intervention on ventilator associated pneumonia(VAP) in neonatal iatensive care unit

目的研究综合性干预措施对新生儿呼吸机相关性肺炎的影响。方法选取2013年1月~2014年1月在本院NICU进行气管插管机械通气的98例患儿,按1∶1配对设计的方法分为观察组49例和对照组49例,观察组患儿采取头高位30°、密闭式吸痰、严格手卫生、口腔护理,使用3 d更换呼吸机管道综合治疗措施。对照组采用常规治疗措施。观察比较两组新生儿的呼吸机相关性肺炎发生率、呼吸机使用时间、住院时间。结果观察组新生儿的呼吸机相关性肺炎发生率10.20%,而对照组的发生率为28.57%,差异有统计学意义,且观察组呼吸机使用时间（60.36±9.23）h明显短于对照组（67.52±8.55）h,观察组住院时间短于对照组（P〈0.05）。结论采用头高位30°、密闭式吸痰、严格手卫生、口腔护理,使用3 d更换呼吸机管可以降低呼吸机相关性肺炎发生率,缩短呼吸机使用时间,减少住院时间。

Objective To obeserve the influence of comprehensive intervention on ventilator associated pneumonia （VAP） in neonatal iatensive care unit. Methods From January 2013 to January 2014, 98 neonates received intubation and mechanical ventilation in neonatal intensive care unit （NICU） were selected and divided into treatment group and control group by 1：1 matched case-control study. And each group had 49 neonates. Preventive factors of treatment group were included levating patient＇s head and chest to 30 degrees to the horizontal level, closed endotraeheal suction systems, washing hands, intensiving frequency of oral-pharyngeal nursing with thorough suction, changing ventiahor tube after three days. While the control group was given routine intervention. The incidence of VAP, the length of hos- pital stay and ventilator time were measured and compared between two groups. Results Compared with control group, neonates in treatment group had lower incidence of VAP （10.20% vs 28.57%） and shorter ventilator time [（60.36＋9.23） h vs （67.52＋8.55h）]. There was difference on hospital stay between the two groups（P〈0.05）. Conclusion The preventive factors including levating patient＇s head and chest to at least 30 degrees to the horizontal level, closed endotracheal suction systems, washing hands, intensiving frequency of oral-pharyngeal nursing with thorough suction, changing venti- ahor tube after three days can reduce incidence of ventilator-associated pneumonia, shorten ventilator time and length of hospital stay.