EICU机械通气患者呼吸机管路细菌学与呼吸道病原菌的调查研究

Investigation of bacteriology and respiratory tract pathogens of ventilator pipes in EICU patients with mechanical ventilation

目的本研究旨在通过对呼吸机管路不同更换频率,呼吸机管路细菌学及下呼吸道细菌学的研究分析,为ICU感染控制及有创机械通气患者人工气道护理措施制定提供依据。方法采用前瞻性随机抽样调查研究方法,入选2012年12月至2015年12月入住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≥3 d的患者,根据患者更换呼吸机管路频率分为3 d组、7 d组和10 d组,比较各组患者呼吸机管路细菌学及下呼吸道细菌学相关性。结果呼吸机管路中检出的细菌以革兰氏阴性杆菌为主,检出率最高的是鲍曼不动杆菌(47.0%),其次为肺炎克雷伯菌(16.7%)和铜绿假单胞菌(12.1%);下呼吸道细菌检出与呼吸机管路细菌检出具有一致性,检出最高为鲍曼不动杆菌(59.6%),其次为肺炎克雷伯菌(19.1%)和铜绿假单胞菌(12.8%)。3 d组呼吸机延长管、呼气段、吸气段、呼气段积液杯、吸气段积液杯的细菌检出率分别为36.7%、36.7%、33.3%、33.3%、20.0%;7 d组细菌检出率分别为73.0%、67.6%、62.2%、62.2%、54.1%;10 d组5个管路部位的细菌检出率均为90.3%。3 d、7 d和10 d组的下呼吸道细菌检出阳性率分别为30.0%、48.6%、64.5%,差异有统计学意义(P<0.05)。结论呼吸机管路使用时间越长,管路细菌污染程度越严重,下呼吸道细菌检出率越高。

Objective To provide references for the intensive care unit(ICU)infection control and nursing measures about invasive mechanical ventilation in patients with artificial airway,by means of analysis of ventilator bacteriology and lower respiratory tract bacteriology on different replacement frequency of ventilator.Methods A prospective randomized sampling survey was conducted.The patients receiving mechanical ventilation for more than 3 days admitted to emergency intensive care unit(EICU)from December 2012 to December 2015 were enrolled.The patients were divided into 3,7 and 10 days groups according to the frequency of ventilator replacement.And the bacteriology of ventilator tubes and the bacteriology of lower respiratory tract were compared between the groups.Results Gram negative bacilli were the main bacteria detected in the ventilator tubes,the highest detection rate of Acinetobacter baumannii(47.0%),followed by Klebsiella pneumoniae(16.7%)and Pseudomonas aeruginosa(12.1%).The bacterial detection of the lower respiratory tract was consistent with that of the ventilator tubes.The highest detection rate was Acinetobacter baumannii(59.6%),followed by Klebsiella pneumoniae(19.1%)and Pseudomonas aeruginosa(12.8%).The bacteria detection rates of extension tube,breathe out,breathe in paragraphs,exhalation cup and inhalation cup were 36.7%,36.7%,33.3%,33.3%and 20.0%in 3 days group,and they were 73.0%,67.6%,62.2%,62.2%and 54.1%in 7 days group,and they were 90.3%in 10 days group.The positive rates of lower respiratory tract bacteria in 3,7 and 10 days group were 30.0%,48.6%and 64.5%respectively,and the differences were statistically significant(P<0.05).Conclusions The longer the ventilator tubes used,the more serious the bacterial contamination of the pipeline,the higher the detection rate of bacteria in the lower respiratory tract.