不同吸痰方式对182例机械通气患者肺部感染发生率的影响

Effect of different methods of endotracheal suction on the incidence of pulmonary infection of 182 patientsundergoing mechanical ventilation

目的探讨机械通气患者中密闭式吸痰与开放式吸痰的临床价值以及吸痰后肺部感染发生情况,为临床采取有效吸痰方式提供指导,并为临床预防与治疗肺部感染提供参考依据.方法选取2016年1月至2016年12月入住重症监护病房（ICU）采取有创机械通气患者182例患者作为研究对象,按痰标本采集方式不同分为试验组和对照组,试验组89例采用密闭式吸痰法,对照组93例采用开放式吸痰法,比较两组患者痰标本阳性率及病原菌检出率,以及吸痰后肺部感染发生情况,所采集数据运用SPSS20.0进行统计分析.结果182例患者采集的617份送检标本中共检出367株阳性菌株,阳性率为59.48%,试验组阳性率为53.74%,对照组阳性率为64.71%,两组比较差异有统计学意义（P〈0.05）.检出病原菌以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、白色念珠菌为主.对照组吸痰后肺部感染发生率为24.73%,明显高于试验组的12.36%,差异有统计学意义（P〈0.05）.结论机械通气患者采用密闭式吸痰标本检测阳性率低于开放式吸痰患者,吸痰后肺部感染发生率明显低于开放式吸痰患者,有较好的临床应用价值.

Objective To study the clinical value of closed endotracheal suction and open endotracheal suction in patients undergoing mechanical ventilation and the incidence of pulmonary infection after endotracheal suction, so as to provide guidance for effective methods of endotracheal suction in clinic, and to provide reference for prevention and treatment of pulmonary infection. Methods A total of 182 patients undergoing invasive mechanical ventilation in ICU from Jan. 2016 to Dec. 2016 were enrolled in the study. 89 cases in the experimental group were treated with closed endotracheal suction, while 93 cases in the control group were treated with open endotracheal suction. The positive rate and the pathogen isolation rate of sputum samples, and the incidence of pulmonary infection after endotracheal suction were compared between the two groups. The statistical analysis of data was performed with the SPSS20.0 software. Results A total of 367 positive bacterial strains were cultured from 617 specimens of 182 patients, with the positive rate of 59.48%; and the positive rateof the experimental group （53.74%） was lower than that of the control group （64.71%） （P〈0.05）. The positive bacterial strains were mainly Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. The incidence of pulmonary infection of the control group after sputum suction （24.73%） was higher than that of the experimental group （12.36%） （P〈0.05）. Conclusion The positive rate of sputum samples of patients with mechanical ventilation undergoing closed endotracheal suction was lower than that of patients undergoing open endotracheal suction, and the incidence of pulmonary infection after sputum suction was lower, closed endotracheal suction had better clinical application value.