CAJ | 학술논문

目的探讨保持呼吸机管路低位对预防呼吸机相关性肺炎(VAP)的影响.方法选取2010年1月至2011年12月ICU行有创机械通气的患者110例,随机(随机数字法)分为对照组(55例)和观察组(55例),对照组常规采取床头抬高30°～ 45°的预防方法,观察组在对照组基础上保持呼吸机管路低位,使呼吸机管路冷凝液不能积存在延长管内并倒流入气道.28 d内观察并记录总体VAP发病率、机械通气时间、ICU平均住院时间、冷凝液倒流情况、临床肺部感染评分(CPIS)动态变化、粗病死率,同时记录两组患者发生误拔管风险.结果观察组和对照组比较,VAP发病率(16.36％vs.34.55％),机械通气时间(5.86±2.66)d vs.(11.24±3.80)d,ICU住院时间(13.60±4.83) dvs.(19.58±5.27)d,冷凝液倒流情况(3.64％vs.49.09％),观察组上述指标均较对照组低,且差异有统计学意义(P＜0.05);观察组中VAP患者的CPIS评分较对照组中VAP患者的低,差异有统计学意义(P＜0.05);观察组粗病死率(21.82％)较对照组(27.27％)低,但是差异无统计学意义(P＞0.05);两组患者发生误拔管风险差异无统计学意义(P＞0.05).结论保持呼吸机管路低位可降低VAP发生率,一定程度改善预后,误拔管风险机率较常规方法无增加.
목적 탐토보지호흡궤관로저위대예방호흡궤상관성폐염(VAP)적영향.방법 선취2010년1월지2011년12월ICU행유창궤계통기적환자110례,수궤(수궤수자법)분위대조조(55례)화관찰조(55례),대조조상규채취상두태고30°～ 45°적예방방법,관찰조재대조조기출상보지호흡궤관로저위,사호흡궤관로냉응액불능적존재연장관내병도류입기도.28 d내관찰병기록총체VAP발병솔、궤계통기시간、ICU평균주원시간、냉응액도류정황、림상폐부감염평분(CPIS)동태변화、조병사솔,동시기록량조환자발생오발관풍험.결과 관찰조화대조조비교,VAP발병솔(16.36％vs.34.55％),궤계통기시간(5.86±2.66)d vs.(11.24±3.80)d,ICU주원시간(13.60±4.83) dvs.(19.58±5.27)d,냉응액도류정황(3.64％vs.49.09％),관찰조상술지표균교대조조저,차차이유통계학의의(P＜0.05);관찰조중VAP환자적CPIS평분교대조조중VAP환자적저,차이유통계학의의(P＜0.05);관찰조조병사솔(21.82％)교대조조(27.27％)저,단시차이무통계학의의(P＞0.05);량조환자발생오발관풍험차이무통계학의의(P＞0.05).결론 보지호흡궤관로저위가강저VAP발생솔,일정정도개선예후,오발관풍험궤솔교상규방법무증가.
Objective To study the role of maintaining ventilator tubing at low position in prevention of ventilator-associated pneumonia (VAP).Methods From January 2010 through December 2011,110 cases with invasive mechanical ventilation in Intensive Care Unit (ICU) were randomly divided into observation group (n =55) and control group (n =55).The patients of control group were given conventional prevention method including the head elevated 30°-45°.The patients of observation group were given prevention method of keeping ventilator tubing at low position in addition to conventional prevention method so as to avoid the condensate in ventilator tubing into the airway.After mechanical ventilation support for 28 days,the incidence of VAP,duration of mechanical ventilation,length of ICU stay,incidence of condensate flowing back,clinical pulmonary infection score (CPIS) and mortality were respectively recorded.At the same time,risk of mistakenly extubation by nurses was recorded.Results The comparison between two groups showed the incidence of VAP (16.36％ vs.34.55％),duration of mechanical ventilation (5.86 ± 2.66) d vs.(11.24 ± 3.80) d,length of stay in the ICU (13.60 ± 4.83) d vs.(19.58 ±5.27) d,incidence of condensate backflow (3.64％ vs.49.09％),presenting significant differences between two groups (P ＜ 0.05).The CPIS of observation group was lower than that of the control group (P ＜0.05),and the mortality in observation group (21.82％) was lower than that in the control group (27.27％),but the difference was not significant (P ＞0.05).There was no statistically significant difference in risk of mistakenly extubation between two groups (P ＞ 0.05).Conclusion Maintaining the ventilator tubing at low position can reduce the incidence of VAP,improve the prognosis,and the risk of mistakenly extubation did not increase compared with the conventional methods