呼吸机管路更换频率对呼吸机相关性肺炎的影响

Influence of different ventilator circuit change frequency on ventilator-associated pneumonia

目的调查呼吸机管路不同更换频率患者呼吸机相关性肺炎（VAP）的发生情况，探讨适宜的更换频率。方法采用前瞻性随机抽样调查研究方法，人选2012年12月至2015年12月昆明医科大学第一附属医院急诊重症加强治疗病房（EICU）接受有创机械通气≥3d的患者，根据患者更换呼吸机管路频率分为3d、7d和10d组，比较各组患者呼吸机管路致病菌检出率及VAP发生率。结果入选98例患者的人工气道建立方式主要为经口气管插管或气管切开，其中男性56例，女性42例；年龄8～86岁，平均（51．97±17．56）岁。3组患者性别、年龄、格拉斯哥昏迷评分（GCS）、咳嗽功能及应用糖皮质激素、肠内营养、雾化和镇静剂治疗等基本资料比较差异均无统计学意义，说明组间危险因素一致。3d组呼吸机延长管、呼气端、吸气端、积液杯的细菌检出率分别为36．7％、36．7％、33．3％、33．3％；7d组细菌检出率分别为73．0％、67．6％、62．2％、62．2％；10d组4个管路部位的细菌检出率均为90．3％。说明在同一更换频率下，不同管路部位细菌检出率基本一致，且呼吸机管路使用时间越长，管路细菌检出率越高（x2值分别为20．599、19．879、21．975、21．975，均P=0．000）；而且呼吸机管路使用时间越长，VAP发生率越高，3d组、7d组、10d组VAP发生率分别为26．7％、59．5％、77．4％，组间比较差异有统计学意义（X2=30．486，P〈0．001）。以3d组为基准，7d组VAP发生率是3d组的15．950倍，10d组VAP发生率是3d组的18．333倍（均P〈0．001）。结论呼吸机管路使用时间越长，管路细菌污染程度越严重，VAP发生率越高。

Objective To explore the appropriate frequency of ventilator tube replacement by researching the influence of different ventilator circuit change frequency on ventilator-associated pneumonia （VAP）. Methods A prospective randomized sampling study was conducted. The patients undergoing invasive mechanical ventilation over or equal to 3 days admitted to emergency intensive care unit （EICU） of the First Affiliated Hospital of Kunming Medical University from December 2012 to December 2015 were enrolled. The patients were divided into 3, 7 and 10 days group according to the frequency of ventilator tube replacement. Bacteriology of ventilator tube and the incidence of VAP were compared among the groups. Results Ninety-eight patients were enrolled, mainly with the artificial airway of endotracheal intubation or traeheotomy, with 56 male and 42 female, aging 8 to 86 years with mean of （51.97 ＋ 17.56） years. There were no statistical differences in gender, age, Glasgow coma scale （GCS） score, cough function and application of glucocorticoid, enteral nutrition, atomization and sedative therapy among three groups, indicating that the risk factors among three groups were consistent. The bacteria detection rates of extension tube, breathe out tube, breathe in tube, and hydrops collection cup were 36.7%, 36.7%, 33.3%, and 33.3% respectively in 3 days group, and they were 73.0%, 67.6%, 62.2%, and 62.2% in 7 days group respectively, and were all 90.3% in 10 clays group. It was showed that the bacteria detection rate in different pipe parts was almost the same with the same change frequency, and the rate was higher with the longer usage of ventilator tube （ X 2 values were 20.599, 19.879, 21.975, 21.975, all P = 0.000）.The longer of the tube used time, the higher incidence of VAP. The incidence of VAP in 3, 7, l0 days groups were 26.7%, 59.5% and 77.4%, respectively, but there was statistically significant difference among all groups （ X 2 -- 30.486, P 〈 0.001）. Based on the value of 3 days group, the incidence of VAP in the 7 days group was 15.950 folds of 3 days group, and the incidence of VAP in the 10 days group was 18.333 folds of the 3 days group （both P 〈 0.001）. Conclusion This study suggests that the longer of pipeline using time, the more serious degree of bacterial contamination of pipeline, the higher incidence of VAP.