持续监控气囊压力在预防机械通气呼吸机相关性肺炎中的应用

Application of a continuous monitoring of balloon pressure to the prevention of ventilator-associated pneumonia

目的 探讨持续监控气囊压力在预防机械通气患者呼吸机相关性肺炎(VAP)中的应用效果。方法 选择2022年1月至2023年6月收治的机械通气患者93例为研究对象,采用随机数字表法分为试验组47例和对照组46例。对照组采用气囊测压表间断监控,试验组采用气囊压力监控仪持续监控,比较2组气囊压力控制达标率、声门下引流量、气道痰液中胃蛋白酶含量、VAP及预后相关指标。结果 试验组气囊压力达标率(99.12%)高于对照组(78.70%)(χ^(2)=119.154,P<0.05);通气第1、2、3天,试验组声门下引流量均高于对照组(P<0.05);插管时、插管后48 h及96 h,试验组胃蛋白酶含量低于对照组(P<0.05);试验组机械通气时间、ICU住院时间短于对照组(P<0.05),VAP发生率(17.02%)低于对照组(39.13%)(χ^(2)=5.642,P<0.05)。结论 持续监控气囊压力能够维持人工气道气囊理想压力,提高机械通气治疗效果,减少VAP的发生率。

Objective To investigate the effect of a continuous monitoring of balloon pressure on the prevention of ventilator-associated pneumonia(VAP).Methods A total of 93 patients with mechanical ventilation treated from January 2022 to June 2023 were selected as the study objects,and they were randomly divided into experimental group(47 cases)and control group(46 cases)by random number table method.Patients in the control group were intermittently monitored by a balloon pressure gauge,and those in the experimental group were continuously monitored by a balloon pressure monitor.The rate of balloon pressure control compliance,subglottic drainage flow,pepsin content in airway sputum,VAP and prognostic indexes were compared between the two groups.Results The balloon pressure compliance rate of the experimental group was significantly higher than that of the control group(99.12%vs 78.70%,χ2=119.154,P<0.05).On the first,second and third day of ventilation,the subglottic drainage flow in the experimental group was significantly higher than that of the control group(P<0.05).At the time of intubation,and 48 h and 96 h after intubation,the pepsin content of the experimental group was significantly lower than that of control group(P<0.05).The mechanical ventilation time and intensive care unit(ICU)stay time of the experimental group were significantly shorter than those of control group(P<0.05).The incidence of VAP of the experimental group was significantly lower than that of the control group(17.02%vs 39.13%,χ2=5.642,P<0.05).Conclusion A continuous monitoring of balloon pressure can maintain the ideal pressure of artificial airway,improve the therapeutic effect of mechanical ventilation and reduce the incidence of VAP.