气管插管持续声门下吸引预防呼吸机相关性肺炎的应用研究

The Study of Intubation with Continuous Subglottic Aspiration on Preventing Ventilator Associated Pneumonia

目的:探讨气管插管持续声门下吸引在预防机械通气患者发生呼吸机相关性肺炎(VAP)中的应用效果。方法:选取2014年6月至2016年12月期间于我院接受机械通气治疗的68例患者作为研究对象,随机分为对照组和研究组各34例。对照组患者给予常规气管插管进行机械通气,而研究组患者给予常规气管插管加持续声门下吸引下进行机械通气。观察并记录两组患者的机械通气时间和ICU入住时间。比较两组患者VAP的发生率和声门下滞留分泌物菌落情况。结果:研究组机械通气时间和ICU入住时间显著低于对照组[(7.23±2.14)d vs(11.86±4.32)d,(14.25±3.48)d vs(19.43±4.21)d,P<0.05];研究组患者VAP的发生率显著低于对照组(14.71%vs 41.18%,P<0.05);研究组患者革兰阳性球菌、非发酵菌和肠杆菌科细菌的发现率分别为5.89%、14.71%和11.76%,均显著低于对照组的23.53%、44.12%和32.35%(P<0.05)。结论:气管插管持续声门下吸引可减少机械通气患者机械通气时间和ICU入住时间,有效预防VAP的发生,利于患者疾病的康复,值得应用于临床。

Objective:To discuss the preventive effects of intubation with continuous subglottic aspiration on ventilator associated pneumonia. Methods:Sixty-eight patients who received mechanical ventilation in our hospital from June 2014 to December 2016 were randomly divided into control group(n=34)and study group(n=34). The patients in the control group were given routine tracheal intubation for mechanical ventilation,while the patients in the study group were treated with routine tracheal intubation combined with continuous subglottic aspiration. The mechanical ventilation time and ICU stay time of the two groups were observed and recorded. The incidence of ventilator-associated pneumonia(VAP)and the prevalence of subglottic secretions in two groups were compared. Results:The mechanical ventilation time and ICU stays were significantly shorter in the research group than those of in the control group[(7.23±2.14)d vs(11.86±4.32)d,(14.25±3.48)d vs(19.43±4.21),P<0.05].The occurrence rate of VAP was shorter in the research group than that in control group(14.71% vs 41.18%,P<0.05). The detection rates of gram positive cocci,non-fermentative bacteria and enterobacteriaceae in the study group were 5.89% 、14.71% and 11.76% in research group,which were all lower than that in control group(P<0.05).Conclusion:intubation with continuous subglottic aspiration can shorten mechanical ventilation time and ICU stays,reduce the occurrence rate of ventilator associated pneumonia and benefit to rehabilitation,which is worthy of clinical use.