外科重症监护室呼吸机相关性肺炎发生与胃食管反流的相关性研究

Study on the relationship between ventilator-associated pneumonia and gastroesophageal reflux in surgical intensive care unit

目的探讨外科重症监护室气管插管患者咽腔及气管内胃蛋白酶浓度与呼吸机相关性肺炎(VAP)发生的关系。方法选取自2014年8月至2018年3月在新疆维吾尔自治区人民医院重症医学二科监护室(SICU)住院并进行机械辅助通气治疗机械通气时间≥48 h的脑出血患者136例。采集患者第48、72 h咽腔及气管分泌物,采用酶联免疫吸附法(ELISA)检测胃蛋白酶,并评价患者的临床肺部感染评分(CPIS),以分析分泌物中胃蛋白酶浓度与肺部感染评分关系。结果136例患者咽腔及气管分泌物中48、72 h胃蛋白酶检出率分别为21.32%(29/136)、47.06%(64/136),其中VAP组气管内分泌物中胃蛋白酶浓度高于非VAP,且差异有统计学意义(P<0.05);VAP组患者气管分泌物胃蛋白酶浓度与肺部感染评分呈正相关。结论外科重症监护室气管插管患者咽腔及气管内胃蛋白酶浓度与VAP相关,但其具体关系机制尚需进一步研究。

Objective Objective to explore the correlation between the concentration of pepsin in pharynx and trachea and the incidence of ventilator-associated pneumonia(VAP)in patients with tracheal intubation in surgical intensive care unit.Methods From August 2014 to March 2018,136 patients with intracerebral hemorrhage who were hospitalized in our intensive care unit(SICU)for more than 48 hours were treated with mechanical ventilation,and their pharyngeal and tracheal secretions were collected at the 48th and 72th hours.Pepsin was detected by enzyme linked immunosorbent assay(ELISA),and their clinical pulmonary infection score(CPIS)was evaluated,to analyze the relationship between pepsin concentration in secretion and CPIs score.Results The detection rate of pepsin in pharyngeal cavity and tracheal secretion of 136 patients with endotracheal intubation was 21.32%(29/136)and 47.06%(64/136)at the 48th and 72th hours,respectively.The concentration of pepsin in tracheal secretion of VAP was higher than that of non VAP,and the difference was statistically significant(P<0.05).There was a correlation between the concentration of pepsin in tracheal secretion of VAP group and CPIs score.Conclusion The concentration of pepsin in pharynx and trachea of patients with tracheal intubation in surgical intensive care unit is closely related to the occurrence ofVAP,but its specificmechanismneeds further study.