不同呼吸机管路对危重症病人VAP发生的影响

THE AFFECT OF DIFFERENT VENTILATOR TUBE SYSTEM ON VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL PATIENTS

目的探讨Fisher＆Paykel MR850呼吸机管路系统与普通PVC管路系统对危重症病人呼吸机相关性肺炎（VAP）发生的影响。方法采用前瞻性实验方法,选取2013年1月—2014年12月入住我院ICU需行有创呼吸机辅助呼吸且符合入选条件的病人240例,随机分为Fisher＆Paykel呼吸机管路组（观察组）120例和普通PVC管路组（对照组）120例,比较两组病人VAP发生率、不同时间点血清降钙素原（PCT）水平、气道分泌物量、呼吸机辅助呼吸时间、ICU驻留时间和总住院时间的差异。结果机械通气前两组病人PCT水平及气道分泌物量比较差异无显著性（P〉0.05）。两组病人机械辅助通气后PCT水平较机械辅助通气前明显升高（F=3.25、5.64,P〈0.05）。机械辅助通气后,观察组病人PCT水平较对照组升高程度低（F=11.64,P〈0.05）。机械辅助通气后,两组病人气道分泌物量较机械辅助通气前明显增多（F=2.91、6.89,P〈0.05）。机械辅助通气后,观察组病人气道分泌物量较对照组升高程度低（F=7.29,P〈0.05）。观察组病人VAP发生率低于对照组（χ~2=8.84,P〈0.05）。观察组病人机械辅助通气时间、ICU住院时间和总住院时间短于对照组（t=2.167~3.251,P〈0.05）。结论Fisher＆Paykel呼吸机管路系统可以显著降低危重症病人VAP的发生率,改善病人临床预后。

Objective To study the affect of ventilator tube system of Fisher＆Paykel（ F＆P） MR850 ventilator and ordinary PVC tube system on ventilator-associated pneumonia（ VAP） in critically ill patients. Methods Applying a prospective experimental method,240 patients treated in ICU in our hospital- from January 2013 to December 2014- who need ventilator-assisted breathing（ VAB）and eligible for inclusion were enrolled. The patients were evenly randomized to F＆P group（ observation group） and PVC group（ control group）. The differences- in incidence rate of VAP,the serum procalcitonin（ PCT） in different time point,volume of airway secretion,time of VAB,length of ICU stay and total length of hospital stay- were compared between the two groups. Results Before VAB,the difference between the two groups was not significant in regard to PCT level and airway secretions（ P 〉 0. 05）. After VAP,the findings in the two groups were as follows： the PCT level in patients in both groups markedly elevated（ F = 3. 25,5. 64; P 〈 0. 05）,the PCT elevation in the observation group was lower than that in the control group（ F = 11. 64,P 〈 0. 05）. The airway secretions in both groups obviously increased（ F = 2. 91,P 〈 0. 05）,and the increase of that in the observation group was lower than that in the control group（ F = 7. 29,P 〈 0. 05）. The incidence of VAP was lower in the observation group than that in the control group（ t = 8. 84,P 〈 0. 05）. The time of VAB,length of ICU stay and total length of hospital stay of patients in the observation group were shorter than that of those in the control group（ t = 2. 167- 3.251,P 〈 0. 05）. Conclusion The Fisher ＆ Paykel ventilator tube system can significantly decrease the incidence of ventilator-associated pneumonia in critically ill patients and improve their prognosis.