强化气道护理在降低ICU患者VAP发生率中的应用效果

Application effects of the strengthened airway nursing in reducing the incidence rate of VAP for ICU patients

目的 探讨强化气道护理在降低ICU患者VAP发生率中的应用价值. 方法 对2012年4月至2014年4月于本院ICU行机械通气治疗的98例患者进行分析,随机分组2组,对照组和实验组各49例. 两组患者在基础治疗和护理的基础上,实验组予半卧位,根据患者自身情况及其舒适度将床头摇高约30度-45度,并在足部垫一软枕以避免身体下滑;改用容易弯曲的小口径胃管（直径为3 mm） ,鼻饲时将患者上半身抬高约30-40°并采取持续泵入的方式,速度为约40-60 ml/h. 而对照组则予常规鼻饲,取侧卧或平卧位,且每次鼻饲体积为150-200 ml. 最后比较两组患者的VAP发生率、通气时间及预后情况. 结果 对照组有20例继发VAP （发生率40. 82%） ,实验组则仅出现9例（发生率18. 37%） ,两组组间比较差异有统计学意义（ P〈0. 05 ）. 实验组的平均通气时间为（9. 89±2. 76）d,明显低于对照组的（16. 07±4. 35）d,差异有统计学意义（P〈0. 05）. 对两组患者的预后比较也发现,实验组的死亡率（12. 24%）明显低于对照组（30. 61%）,组间差异显著（P〈0. 05）. 结论 发生VAP的机制复杂、危险因素多,行机械通气的重症患者只有在积极治疗的基础上加强气道护理,才能减少VAP的发生、提高救治成功率.

Objective To investigate the value of strengthened airway nursing in reducing the incidence rate of VAP for ICU patients. Methods A total of 98 cases of ICU patients who were treated with mechanical ventilation from April 2012 to April 2014 in our hospital were analyzed, and were randomly divided into control group and experimental group, with 49 cases in each group. The two groups＇ patients were all given the regular treatments and nursing, mean-while the patients of experimental group were treated in semi-reclining position with the bed elevated about 30 to 45 de-grees according to the patient＇s practical situation and comfort, and a soft pillow pad was installed at the foot to avoid the body decline;a small flexible nasogastric tube was used instead （diameter 3mm）, the upper body of the patients will be elevated about 30 to 40 degrees when nasogastric feeding was given by the way of continuous pump, and the speed keeps at about 40- 60 ml/h. While the control group was treated with conventional nasal feeding in the lateral or supine posi-tion, and each feeding volume was 150-200 ml. The incidence of VAP, aeration time and its prognosis of patients of the two groups were compared finally. Results There were 20 cases of secondary VAP in control group （ incidence rate 40. 82%） , and 9 cases in experimental group （ incidence rate 18. 37%） . The differences of the two groups were statis-tically significant （P〈0. 05） . The average duration of ventilation of the experimental group was （9. 89 ＋ 2. 76） days, which was significantly shorter than that of the control group, （16. 07±4. 35） days, and the differences were statistically significant （ P〈0. 05 ） . The comparison of the prognosis of patients in two groups was also found that the mortality of ex-perimental group （12. 24%） was significantly lower than that of the control group （30. 61%） , and the differences be-tween the two groups were significant （ P〈0. 05 ） . Conclusion The mechanism of the incidence of VAP was complex and the risk factors were multiple;severe patients with mechanical ventilation should be conducted with strengthened air-way nursing on basis of positive treatment to reduce the occurrence of VAP and increase the rate of successful treatment.