综合干预方案对新生儿呼吸机相关性肺炎的影响

Effect of comprehensive intervention program on neonatal ventilator-associated pneumonia

目的探讨应用综合干预方案对新生儿呼吸机相关性肺炎(VAP)的预防作用,为临床应用提供参考依据。方法选取2014年1月-2015年12月医院新生儿重症监护病房(NICU)收治的行机械通气(MV)的新生儿106例为研究对象,随机分为观察组和对照组,两组各53例,对照组患儿给予常规护理,观察组患儿给予密闭式湿化方法联合细致化口腔护理的综合干预方案,统计VAP患儿的病原菌分布,比较两组VAP、MV时间、NICU住院天数、总住院天数、病死率及患儿家属对口腔护理的满意度。结果 106例患儿共发生VAP23例,发生率为21.7%,其中革兰阴性菌感染最多见(94.4%);观察组患儿VAP发生率、MV时间、NICU住院天数、总住院天数均显著低于对照组,差异有统计学意义(P<0.05);观察组患儿家属的满意度评价结果及总满意率均显著优于对照组,差异有统计学意义(P<0.05)。结论对行MV的NICU新生儿而言,采用综合干预方案能降低VAP的发生风险,缩短MV时间和住院时间,提高患儿家属的满意度,值得临床推广应用。

OBJECTIVE To investigate the preventive effect of comprehensive intervention program on neonatal ventilator-associated pneumonia （VAP）, so as to provide reference for clinical application. METHODS A total of 106 neonatal received mechanical ventilation （MV） in neonatal intensive care unit （NICU） from Jan. 2014 to Dec. 2015 were enrolled in the study and randomly divided into observation group and control group, with 53 cases in each group. Patients in control group were given conventional nurse while in observation group were given com- prehensive intervention program including closed wetting method and meticulous oral nursing. Pathogen distribution and composition ratio were recorded in all patients with VAP. The incidence of VAP, duration of MV, length of NICU stays, total hospital stays, mortality and the satisfaction of children families for oral care were compared between the two groups. RESULTS Of all 106 patients, VAP occurred in 23 cases, with the total incidence rate was 21.7 ~. Gram-negative bacteria were the most common pathogenic bacteria （94.4 %）. The incidence of VAP, duration of MV, length of NICU stays, and total hospital stays of observation group were significantly lower than those of control group （P〈0. 05）. The satisfaction children families and total satisfaction rate of observation group were significantly better than those of control group （P〈0.05）. CONCLUSION For children receiving MV in NICU, comprehensive intervention program can significantly reduce the risk of VAP, shorten the duration of MV and hospital stay, and improve the satisfaction of children families, so it is worthy of clinical application.