有创机械通气患者呼吸机湿化液更换频率的研究

Study on the frequentcy of replacing moisturized liquid of ventilator for patients undergoing invasive mechanical ventilation

目的探讨有创机械通气患者呼吸机湿化液更换频率,以降低患者呼吸机相关性肺炎发生率。方法将82例气管插管行有创呼吸机通气治疗持续10d以上患者随机分为两组各41例,两组均使用输液器连接湿化罐滴注的方法进行匀速注水,均在第7天更换呼吸机管道及湿化罐。观察组更换湿化罐及呼吸机管道时才更换湿化罐内湿化液,对照组每日更换湿化液。比较两组呼吸机相关性肺炎发生率及不同部位细菌阳性率。结果观察组在呼吸机治疗10d时呼吸机相关性肺炎发生率显著低于对照组(P<0.05),患者咽峡部、下呼吸道、呼吸机管路及湿化罐细菌阳性率显著低于对照组(均P<0.01)。结论对有创呼吸机辅助通气治疗患者,湿化液每周更换1次优于每日更换,可减少细菌定植,减少呼吸机相关性肺炎的发生。

Objective To explore the best frequentcy of replacing moisturized liquid of ventilator for patients undergoing invasive me- chanical ventilation, and to reduce the incidence of ventilator associated pneumonia. Methods A total of 82 patients undergoing inva sive mechanical ventilation therapy via tracheal intubation for more than 10 days were randomized into an observation group and a control group, with 41 cases in each group. Both groups were implemented a constant water injection by connecting infusion appara tus and humidification bottle, and the ventilator tube and humidification bottle were replaced on the 7th day. The moisturized liquid of the ventilator in the observation group was replaced at the same time as the ventilator tube and humidification bottle, while it was replaced each day in the control group. The incidence of ventilator associated pneumonia and the positive rate of bacteria in different parts were compared between the two groups. Results When underwent invasive mechanical ventilation for 10 days, the incidence of ventilator associated pneumonia in the observation group was significantly lower than that in the control group （P 〈0.05）, and the positive rate of bacteria in patients＇ pharynx isthmusand and lower respiratory tract, ventilator tube and humidification bottle were significantly lower than those in the control group （P〈0.05 for all）. Conclusion For the patients undergoing invasive ventilator assissted ventilation, weekly replacement of moisturized liquid of ventilator is better than daily replacement, and it is conducive to reduce bacterial colonization and ventilator associated pneumonia.