CAJ | 학술논문

目的探讨ICU患者早期集束化气道干预对预防呼吸机相关性肺炎(VAP)的作用.方法选取入住ICU行有创机械通气的患者128例,随机分为对照组64例和观察组64例.对照组采取常规气道干预,观察组在4h内采取集束化气道干预(及时倾倒呼吸机管路冷凝水、人工气囊的压力保持在20～30 cmH2O、胸部物理治疗每2小时1次、持续声门下吸引、呼吸机采用热湿交换器、每4小时洗必泰口腔冲洗).观察并记录两组VAP发病率、平均机械通气时间、ICU平均住院时间及28 d的病死率.动态观察确诊VAP患者当天(0)、3、5、7、14 d时临床肺部感染评分(CPIS)、APACHEⅡ评分.结果观察组与对照组比较,VAP发病率(18.75％与35.94％)、平均机械通气时间(6.26±2.89)d与(10.54±4.36)d、ICU平均住院时间(11.88±3.97)d与(16.55±5.22)d,观察组均较对照组低,且差异有统计学意义(x2=4.758、t=6.546、t=5.697,P＜0.05或P＜0.001).两组中确诊VAP3、5、7、14 d,CPIS评分分别为(7.01±2.24)、(8.74±2.33)分,(5.67±2.14)、(7.51±2.27)分,(4.36±1.44)、(6.95±2.98)分,(2.75±1.37)、(6.53±2.88)分,观察组的CPIS评分均较对照组低,差异有统计学意义(F组间=27.22,P＜0.001;F组内=29.41,P＜0.001;F交互=4.35,P＜0.01);APACHEⅡ评分分别为(17.02±7.06)、(22.48 ±7.31)分,(15.01±6.06)、(19.67±7.14)分,(12.40±4.17)、(16.13±5.33)分,(8.40±2.57)、(13.10±4.93)分,观察组的APACHEⅡ评分较对照组低,差异有统计学意义(F组间=47.43,P＜0.001;F组内=45.36,P＜0.001;F交互=4.25,P＜0.01).结论早期应用集束化气道干预可降低VAP的发生率,一定程度改善病情及预后.
목적 탐토ICU환자조기집속화기도간예대예방호흡궤상관성폐염(VAP)적작용.방법 선취입주ICU행유창궤계통기적환자128례,수궤분위대조조64례화관찰조64례.대조조채취상규기도간예,관찰조재4h내채취집속화기도간예(급시경도호흡궤관로냉응수、인공기낭적압력보지재20～30 cmH2O、흉부물리치료매2소시1차、지속성문하흡인、호흡궤채용열습교환기、매4소시세필태구강충세).관찰병기록량조VAP발병솔、평균궤계통기시간、ICU평균주원시간급28 d적병사솔.동태관찰학진VAP환자당천(0)、3、5、7、14 d시림상폐부감염평분(CPIS)、APACHEⅡ평분.결과 관찰조여대조조비교,VAP발병솔(18.75％여35.94％)、평균궤계통기시간(6.26±2.89)d여(10.54±4.36)d、ICU평균주원시간(11.88±3.97)d여(16.55±5.22)d,관찰조균교대조조저,차차이유통계학의의(x2=4.758、t=6.546、t=5.697,P＜0.05혹P＜0.001).량조중학진VAP3、5、7、14 d,CPIS평분분별위(7.01±2.24)、(8.74±2.33)분,(5.67±2.14)、(7.51±2.27)분,(4.36±1.44)、(6.95±2.98)분,(2.75±1.37)、(6.53±2.88)분,관찰조적CPIS평분균교대조조저,차이유통계학의의(F조간=27.22,P＜0.001;F조내=29.41,P＜0.001;F교호=4.35,P＜0.01);APACHEⅡ평분분별위(17.02±7.06)、(22.48 ±7.31)분,(15.01±6.06)、(19.67±7.14)분,(12.40±4.17)、(16.13±5.33)분,(8.40±2.57)、(13.10±4.93)분,관찰조적APACHEⅡ평분교대조조저,차이유통계학의의(F조간=47.43,P＜0.001;F조내=45.36,P＜0.001;F교호=4.25,P＜0.01).결론 조기응용집속화기도간예가강저VAP적발생솔,일정정도개선병정급예후.
Objective To investigate the effect of early airway bundle intervention on prevention ventilator-associated pneumonia(VAP) in ICU patients.Methods One hundred and twenty-eight patients with invasive mechanical ventilation in ICU were randomly divided into the control group (64 cases) and observation group(64 cases).Patients in the control group were given conventional airway intervention,and in the observation group were given airway bundle intervention within 4 h including dumping of condensed water in tubing of breathing machine in time,keeping pressure of artificial airbags from 20 to 30 cm H2 O,chest physical therapy 2 h/time,continuous aspiration of subglottic secretion,using moisture exchanger in breathing machine,and mouth rinse by chlorhexidlne 4 h/time.Incidence of VAP,duration of mechanical ventilation,duration of stay in the ICU and mortality within 28-day were recorded.Clinical Pulmonary Infection Score (CPIS) and APACHE Ⅱ at 0,3rd,5th,7th,14th day were recorded respectively.Results The incidence of VAP,duration of mechanical ventilationand duration of stay in the ICU in observation group were 18.75％,(6.26 ± 2.89) d,(11.88 ± 3.97) d respectively,lower than those in control group (35.94％,(10.54 ± 4.36) d,(16.55 ±5.22) d)),and the differences were significant (x2=4.758,t =6.546,t =6.546,P＜0.05 orP＜0.01).At 3rd,5th,7th,14th day after diagnosed VAP,CPIS of patients with confirmed VAP in observation group were 7.01 ±2.24,5.67 ±2.14,4.36 ± 1.44,2.75 ± 1.37 respectively,lower than those in control group(8.74 ± 2.33,7.51 ± 2.27,6.95 ± 2.98,6.53 ± 2.88,and the differences were significant (Finter group =27.22,P ＜ 0.001 ; Fbetween group =29.41,P ＜ 0.001 ; Finteraction =4.35.P ＜ 0.01).APACHE Ⅱ were 17.02 ± 7.06,15.01 ± 6.06,12.40 ± 4.17,8.40 ± 2.57 respectively,significant lower than those in control group ((22.48 ±7.31,19.67 ± 7.14,16.13 ± 5.33,13.10 ± 4.93),and the differences were significant (Finter group =47.43,P ＜ 0.001 ; Fbetween group =45.36,P ＜ 0.001 ; Finteraction =4.25,P ＜ 0.01).Conclusion Early using airway bundle interventions on ICU patients can reduce the incidence of VAP,improve the condition and prognosis.