基于最佳证据的人工气道气囊护理对老年AECOPD机械通气患者VAP的预防作用研究

Study on preventive effects of artificial airway balloon nursing based on the best evidence on VAP in elderly AECOPD patients undergoing mechanical ventilation

目的探讨基于最佳证据的人工气道气囊护理对老年慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者呼吸机相关性肺炎(VAP)的预防作用。方法回顾性纳入2020年9月—2024年2月南京医科大学附属脑科医院收治的108例老年AECOPD患者,按照不同护理方式分为对照组与观察组,每组54例。对照组实施针对机械通气的常规护理干预,观察组实施基于最佳证据的人工气道气囊护理干预。比较2组VAP发生率、24 h内气囊压力达标率;观察并比较2组气囊滞留物引流量(插管后1、3、5 d时)、血气分析指标值[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]及不良事件发生率。结果观察组VAP发生率低于对照组(P<0.05);观察组24 h内气囊压力达标率高于对照组(P<0.05);2组插管后不同时间点气囊滞留物引流量、PaCO_(2)、PaO_(2)变化均存在交互效应(P<0.001);插管后3、5 d时,2组气囊滞留物引流量、PaO_(2)均升高(P<0.05),且观察组气囊滞留物引流量、PaO_(2)均高于对照组(P<0.05);气管插管后3、5 d时,2组PaCO_(2)均降低(P<0.05),且观察组PaCO_(2)低于对照组(P<0.05);2组不良反应发生率差异无统计学意义(P>0.05)。结论基于最佳证据的人工气道气囊护理可降低老年AECOPD患者VAP发生风险,提升人工气道气囊内压力控制与滞留物清除效果,改善患者血气状态。

Objective To explore the preventive effects of artificial airway balloon nursing based on the best evidence on ventilator-associated pneumonia(VAP)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods 108 elderly patients with AECOPD admitted to Brain Hospital Affiliated to Nanjing Medical University from September 2020 to February 2024 were retrospectively included.According to different nursing methods,they were divided into control group and observation group,with 54 cases in each group.The control group received conventional nursing interventions for mechanical ventilation,while the observation group received artificial airway balloon nursing based on the best evidence.The incidence of VAP and compliance rate of balloon pressure within 24 h were compared between the two groups.The drainage volume of balloon retention(at 1,3 and 5 d after intubation),blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))],and incidence of adverse events were observed and compared between the two groups.Results The incidence of VAP in the observation group were lower than that in the control group(P<0.05).The compliance rate of balloon pressure within 24 h in the observation group was higher than that in the control group(P<0.05).There were interaction effects in the changes of drainage volume of balloon retention,PaCO_(2) and PaO_(2) at different time points after intubation between the two groups(P<0.001).At 3 and 5 days after intubation,the drainage volume of balloon retention and PaO_(2) in both groups increased(P<0.05)and the observation group was higher than control group(P<0.05);PaCO_(2) in both groups decreased(P<0.05)and the observation group was lower than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Artificial airway balloon nursing based on the best evidence can reduce the risk of VAP in elderly AECOPD patients,improve the effects of pressure control and retention removal in artificial airway balloon,and improve the blood gas status of patients.