阻断病原学特性预防呼吸机相关性肺炎媒介管理策略构建与临床实践

Construction and clinical practice of vector management strategy for preventing ventilator-associated pneumonia by blocking etiological characteristics

目的从病原学特性的角度构建预防呼吸机相关性肺炎媒介管理策略并验证其应用效果。方法在抽样调查的基础上,基于优势菌种的病原学特性,从定植患者及感染患者管理2个方面,构建阻断病原学特性预防呼吸机相关性肺炎(VAP)媒介管理策略。2021年7月至2023年6月,采用非同期随机对照研究,随机抽取天津市泰达医院ICU机械通气患者(对照组59例,试验组57例)证实该策略的有效性。结果对照组男35例,女24例,年龄(46.97±18.84)岁;试验组男39例,女18例,年龄(47.49±13.85)岁。研究期对照组发生VAP 9例,试验组发生VAP 2例,2组比较差异有统计学意义(P=0.031)。机械通气时长试验组(122.41±18.36)h,短于对照组的(187.62±18.05)h,差异有统计学意义(t=19.28,P<0.05);ICU住院时长试验组(8.38±0.79)d,短于对照组的(10.99±1.10)d,差异有统计学意义(t=14.66,P<0.05);第7天痰培养病原菌阳性试验组为7例,少于对照组的29例,差异有统计学意义(χ^(2)=16.73,P<0.05)。结论阻断病原学特性预防VAP媒介管理策略能够降低VAP发生率,缩短机械通气时间与ICU住院时间,减少机械通气患者第7日呼吸道深部组织痰液中病原菌载量。

Objective To establish an environmental management strategy for the prevention of ventilator-associated pneumonia from the perspective of etiological characteristics and to verify its application effect.Methods Based on a sampling survey,this study constructed preventive management strategies for ventilator-associated pneumonia by blocking pathogen characteristics from the perspective of both colonization and infection management in patients.From July 2021 to June 2023,a non-synchronous randomized controlled study was conducted,including a control group of 59 cases and an experimental group of 57 cases from ICU of Tianjin Teda Hospital,all of them were mechanically ventilated patients.The effectiveness of the strategy was confirmed.Results In the control group,there were 35 males and 24 females,with an average age of(46.97±18.84)years.In the experimental group,there were 39 males and 18 females,with an average age of(47.49±13.85)years.During the study period,there were 9 cases of ventilator-associated pneumonia(VAP)in the control group and 2 cases in the experimental group,the difference between the two groups was statistically significant(exact odds ratio=0.031).The duration of mechanical ventilation in the experimental group(122.41±18.36)h,which was shorter than that in the control group(187.62±18.05)h,and the difference was statistically significant(t=19.28,P<0.05).The length of ICU stay in the experimental group was(8.38±0.79)d,in the control group was(10.99±1.10)d,the difference between them was statistically significant(t=14.66,P<0.05).On the 7th day,there were 7 cases of positive pathogenic bacteria in sputum culture in the experimental group,which was significantly different from the 29 cases in the control group(χ^(2)=16.73,P<0.05).Conclusions The vector management strategy for preventing ventilator-associated pneumonia by blocking etiological characteristics can reduce the incidence of VAP,shorten the duration of mechanical ventilation and ICU stay,and reduce the pathogen load in the sputum of mechanically ventilated patients on the 7th day.