气管插管间歇性气囊上方吸引对呼吸机相关性肺部感染的影响分析

Influence analysis of different endotracheal intubation with intermittent above attracting for severe patients with ventilation-associated pneumonia

目的比较传统的气管切开插管与带有气囊上方吸引的气管切开插管对呼吸机相关性肺炎(VAP)的影响,为临床选择最佳气管插管方案提供参考依据。方法选取2013年6月-2015年5月医院行气管插管的1067例脑血管患者作为研究对象,根据气管插管方案的不同,将其中行传统气管切开插管的516例患者列为传统组,另行带有气囊上方吸引气管切开插管的551例患者列为气囊组,比较两组患者VAP的发生率及治疗后的疗效,数据采用SPSS 17.0软件进行统计分析。结果气囊组VAP发生率明显低于传统组,其中气囊组迟发型VAP发生率则明显降低(P<0.05);气囊组患者插管时间和ICU住院时间均较传统组患者明显缩短(P<0.05);与传统组相比,气囊组患者单一病原菌感染患者较多,而两种病原菌感染和≥3种病原菌感染患者则明显减少(P<0.05),差异均有统计学意义;传统组患者气管插管后2min气道峰压和气道平台压均比插管前明显增加,而肺顺应性则较插管前明显降低,差异有统计学意义(P<0.05)。结论带有气囊上方吸引的气管切开插管,能减少病原菌的感染,有效降低VAP的发生率,并缩短患者的插管时间和ICU住院时间。

OBJECTIVE To study the influence of tracheotomy intubation with a balloon above attract for severe patients with ventilation-associated pneumonia compared with traditional tracheotomy intubation,so as to provide the basis for clinical choice best endotracheal intubation.METHODS A total of 1067 cases of cerebrovascular patients with trachea cannula in hospital from Jun.2013 to May 2013 were selected as the research objects.According to the scheme of endotracheal intubation,the 516 cases of patients who had the traditional tracheotomy intubation were traditional group,and the 551 cases of patients who had trachea cannula with a balloon above were airbag group,and the occurrence of ventilator associated pneumonia（VAP）and prognosis of patients were compared in two groups.SPSS 17.0was used for statistic analysis.RESULTS The VAP incidence of the airbag group was significantly lower than that of the traditional group,and the late onset VAP incidence was decreased obviously（P〈0.05）.The trachea cannula time and the ICU hospitalized time of airbag group were significantly reduced than that of the traditional group patients（P〈0.05）.Compared with traditional group,the single pathogen infection number in airbag group was more,and the two kinds of pathogen infection and three or more pathogenic bacteria infections were decreased significantly（P〈0.05）.The peak andplat airway pressure of patients with intubation 2min in traditional group were significantly increased than before intubation,and pulmonary compliance was significantly lower than before intubation（P〈0.05）.CONCLUSION The trachea cannula scheme with a balloon above attract can effectively reduce the incidence of VAP,and shorten the patient＇s intubation time and ICU length of hospital stay by reducing the infection of pathogenic bacteria.