间断声门下灌洗结合持续声门下吸引在经口气管插管机械通气中的应用

Applicationof discontinuous subglottic lavage combine with continuous aspiration of subglottic secretions for orotracheal intubation

目的:探讨经口气管插管患者应用间断声门下灌洗(DSLC)结合持续声门下吸引(CASS)对呼吸机相关性肺炎(VAP)的影响。方法:按照声门下吸引方式不同将110例行经口气管插管机械通气的患者分为实验组(DSLC结合CASS)58例和对照组(CASS)52例,对比2组患者下呼吸道分泌物检测结果、附加管堵塞次数、气囊上滞留物吸除量、总住院时间以及VAP发生情况。结果:实验组患者下呼吸道分泌物细菌检出率显著低于对照组(P<0.05);实验组患者附加管堵塞次数及总住院时间显著低于对照组,气囊上滞留物吸除量显著高于对照组,VAP发生率显著低于对照组(P<0.05)。结论:经口气管插管患者应用DSLC结合CASS方式清理气囊上滞留物能够有效降低下呼吸道分泌物细菌检出率,提高气囊上滞留物吸除效果,降低VAP发生率。

Objective]To investigate the effects of intermittent irrigation （CASS） combined with continuous intermittent irriga-tion （DSLC） on ventilator associated pneumonia （VAP） in patients with oral endotracheal intubation .[Method] 110 cases of patients with orotracheal intubation were divided into experiment group （58 cases ） and control group （52 cases ） . The control group was treated withCASS and the experiment group was treated withDSLC＋CASS .The results of subglottic secretion test , blockage times of additional pipe ,retention of air bag ,total length of hospital stay and VAP were compared .[Result]The rate of subglottic secretion bacteria of the experiment group were lower than that of the control group （ P〈0 .05 ）;There was no sig-nificant difference on the rate of fungus（P〉0 .05） .The blockage timesof additional pipe ,total length of hospital stay of the experiment group were lower than that of the control group （ P〈0 .05 ） .Retentateabsorption capacity on the airbags of the exper-iment group was higher than the control group （ P〈0 .05 ）;The rate of VAPof the experiment group was lower than the control group（ P〈0 .05） .[Conclusion]DSLC with CASScan reduce the rate of subglottic secretion bacteria for the patients with oro-tracheal intubation ,increases the airbags on the retentategettering effect and reduces the rate of VAP .It has clinically proven ef-fective .