具有声门下吸引功能的气管插管对呼吸机相关性肺炎发生率的影响

Influence of the Use of Endotracheal Tube With Lumen for Subglottic Secretion Drainage(SSD) on the Incidence of Ventilator-associated Pneumonia

背景有研究表明,采用具有声门下吸引(SSD)功能的气管插管可以降低呼吸机相关性肺炎(VAP)发生率,但是某些研究结论与之相反。目的探讨具有SSD功能的气管插管对VAP发生率的影响。方法选取2014年1—12月武警后勤学院附属医院综合重症监护室(ICU)中符合纳入与排除标准的患者298例为研究对象。根据气管插管方式的不同,将其分为观察组(采用具有SSD功能的气管插管,148例)和对照组(采用常规气管插管,150例)。记录患者性别、年龄、入院类型(术后、内科疾病、创伤)、是否使用肌肉松弛剂、急性生理与慢性健康评分系统(APACHE)Ⅱ评分、机械通气时间、是否气管切开、是否再插管、VAP发生率、VAP发病率。结果观察组VAP发生率、VAP发病率均低于对照组(P<0.05)。单因素Logistic回归分析结果显示,采用气管插管类型、年龄、是否使用肌肉松弛剂、APACHEⅡ评分、机械通气时间、是否气管切开、是否再插管是VAP的影响因素(P<0.05)。多因素Logistic回归分析结果显示,采用气管插管类型、年龄、APACHEⅡ评分、机械通气时间、是否再插管是VAP的影响因素(P<0.05)。观察组无VAP累积发生率高于对照组(P<0.05)。结论对于ICU住院机械通气时间>48 h的患者,采用具有SSD功能的气管插管可降低VAP发生率;高龄、较高的APACHEⅡ评分、较长的机械通气时间、再插管亦是VAP的影响因素,临床医生应对这些因素给予足够重视。

Background Although the use of endotracheal tube（ ETT） with lumen for subglottic secretion drainage（ SSD） can reduce the incidence of ventilator- associated pneumonia（ VAP） in some studies,the influence of SSD in preventing VAP remains controversial. Objective To investigate the influence of ETT with SSD function on the incidence of VAP. Methods From January to December in 2014,enrolled 298 patients who accorded with the inclusion and exclusion criteria from the ICU of the Affiliated Hospital of Logistics College of the Chinese People＇ s Armed Police Forces. According to different ETT methods,the subjects were divided into two groups： observation group（ SSD, n = 148） and control group（ conventional method, n= 150）. Gender,age,hospitalization type（ post operation, internal medicine diseases, trauma）, whether muscle relaxant was used,acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） score,mechanical ventilation time,tracheotomy,reintubation,VAP incidence and VAP morbidity of the subjects were recorded. Results The observation group was lower than control group in VAP incidence and VAP morbidity（ P〈0. 05）. Univariate Logistic regression analysis showed that ETT type,age,whether muscle relaxant was used, APACHE Ⅱ score, mechanical ventilation time, tracheotomy and reintubation were influencing factors for VAP（ P〈0. 05）. Multivariate Logistic regression analysis showed that ETT type,age,APACHEⅡscore,mechanical ventilation time and reintubation were influencing factors for VAP（ P〈0. 05）. The observation group was higher than control group in the accumulated incidence rate of non- VAP（ P〈0. 05）. Conclusion For ICU patients with mechanical ventilation time 48 h, ETT with SSD function can reduce the incidence of VAP. Age, higher APACHE Ⅱ score, longer mechanical time and reintubation are influencing factors for VAP. Clinical doctors should attach more importance on these factors.