摘要
目的用简易有效的方法降低呼吸机相关性下呼吸道感染(VALRI)的发生。方法对入住综合重症监护病房有创呼吸机支持呼吸的患者随机分成研究组(气管导管抗菌处理组)和对照组,两组定期同步对导管内壁和下呼吸道分泌物进行细菌学检测,并记录患者机械通气时间、呼吸机相关性下呼吸道感染的出现时间、病死率。结果机械通气(MV)5 d内,研究组呼吸机相关性肺炎(VAP)、呼吸机相关性气管-支气管感染(VARI)的发生率(4.8%、8.4%)显著低于对照组(16.7%、22.6%,P<0.05);研究组VAP、VARI的发生时间〔(10.3±4.2)d、(9.4±3.0)d〕均晚于对照组〔(4.5±2.8)d(、4.0±2.4)d〕;研究组MV的时间(14±18)d短于对照组(22±20)d;研究组病死率(8.3%)低于对照组(20.2%),比较差异均有统计学意义(P<0.05);86.5%患者下呼吸道分泌物在检出病原菌前,气管导管内就检出了该病原菌。结论气管导管抗菌处理后可以降低早发VALRI的发生率,可以使VARI和VAP的发生时间延迟,缩短MV时间,降低病死率;包括气管导管抗菌处理在内的优化捆绑治疗措施是防治VALRI的最佳策略。
OBJECTIVE To reduce the occurrence of ventilator associated lower respiratory infection（VALRI） with the simple effective method. METHODS All studied patients who received mechanical ventilation（MV） in ICU were divided into the study group （antibacterial-processed endotracheal tube group） and the control group. Bacterial culture of samples from endotracheal tube inwall and lower respiratory tract were obtained periodically. The clinical data such as the duration of MV, the time of occurrence of VALRI, and the case fatality rate were recorded and analyzed. RESULTS In patients with MV〈5 days： the incidence of VAP and ventilator-associated respiratory infection（VARI） in the study group （VAP： 4.8% and VARI： 8. 4% ）were lower than those in the control group （VAP：16.7% and VARI：22. 6%,P〈0.05）. The onset of VAP and VARI was delayed in the study group [VAP： （10.3± 4.2）d and VARI： （9.4±3.0）d） as compared with the control group [VAP： （4.5± 2.8）d and VARI：（4.0±2.4）d,P〈0.05]. The MV time of the study group （14±18） d was shorten than the control group （22±20） d. The mortality of the study group （8.3%） was lower than that of the control group （20.2%）. There were singnificant statistical differences between them. The same organism that previously found from endotracheal tube inwall was existed in the next lower respiratory tract secretion in 86. 5% patients. CONCLUSIONS The usage of antibacterial-processed endotracheal tube can reduce the MV time, the mortality rate and the incidence of VAP and VARI in patients with MV〈5 d. The onset of VARI and VAP is delayed in the study group compared with the control group. The optimized bundle treatment including antibacterial-processed endotracheal tube is the best strategy for preventing and controlling VALRI.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第16期2118-2120,共3页
Chinese Journal of Nosocomiology
关键词
气管导管抗菌处理
呼吸机相关性下呼吸道感染
优化捆绑治疗
机械通气
Antibacterial-processed endotracheal tube
Ventilator associated lower respiratory infection
Optimized bundle treatment
Mechanical ventilation
