床旁纤维支气管镜气道维护对ICU重症合并VAP患者30-d临床结局的影响

Effect of airway maintenance with bedside fiberoptic bronchoscopy on 30-day clinical outcomes in ICU severe patients with VAP

目的 探讨床旁纤维支气管镜(纤支镜)气道维护对ICU重症合并呼吸机相关性肺炎(VAP)患者30-d临床结局的影响。方法 ICU重症合并VAP患者75例分为治疗组(42例)和对照组(33例)。ICU重症患者确诊VAP后7 d内,治疗组行床旁纤支镜气道维护每日1次,对照组行常规负压吸痰气道维护每日1次。两组患者必要时增加气道维护次数。比较两组确诊VAP后7 d内气道维护次数和30-d临床结局。结果 与对照组比较,治疗组VAP确诊后7 d内气道维护次数减少,体温恢复时间、ICU停留时间和感染病灶消散时间缩短,痊愈出院比例升高,ICU死亡率降低(P<0.01或P<0.05)。结论 床旁纤支镜气道维护可改善ICU重症合并VAP患者30-d临床结局,促进患者康复。

Objective To explore the effect of airway maintenance with bedside fiberoptic bronchoscopy on the 30-day clinical outcomes of ICU severe patients with ventilator-associated pneumonia(VAP).Methods A total of 75 ICU severe patients with VAP were divided into two groups of A(42 cases)and C(33 cases).Within 7 days after VAP diagnosis,group A received airway maintenance with bedside fiberoptic bronchoscopy once a day,while group C received airway maintenance of routine negative pressure suction spittoon once a day.The frequency of airway maintenance in both groups was increased when it is necessary.Airway maintenance times within 7 days after the diagnosis of VAP and 30-day clinical outcomes were compared between the two groups.Results Compared with group C,group A had less airway maintenance times within 7 days after VAP diagnosis,more proportions of the patients with less ICU stay,shorter times of temperature recovery and the lesion dissipation,and lower ICU mortality(P<0.01 or P<0.05).Conclusion Airway maintenance with bedside fiberoptic bronchoscopy can improve the 30-day clinical outcomes and promote the recovery of ICU severe patients with VAP.