摘要
目的探讨以声门上、下吸引为基础的改良呼吸机集束化管理（modifiedventilatorcarebundle，mVCB）对呼吸机相关性肺炎（VAP）的预防作用。方法回顾性分析上海市第五人民医院急诊-危重病医学科2011-01—2014-12收治的需有创机械通气治疗的609例患者，收集患者年龄、性别、基础疾病、VAP发病情况、机械通气时间、住院时间及住ICU时间，分析并比较mVCB实施前后（2013-01前后）机械通气患者VAP发病率、平均机械通气时间、平均住院时间和平均住ICU时间之间的差异。结果Kaplan-Meier生存分析显示，VAP患者死亡率大于非VAP患者（P=0．0049）。与mVCB实施前比较，mVCB实施后，机械通气患者VAP发病率显著降低（10．8例／1000机械通气时间比6．4例／1000机械通气时间，P=0．0348），且机械通气时间显著减少[（12．8±4．2）d比（13．6±5．3）d，P=0．0258]，平均住院时间显著减少[（26．8±6．2）d比（28．6±9．6）d，P=0．0078]，平均住ICU时间显著减少[（19．9±4．9）d比（21．3±7．5）d，P=0．0063]。多元Logistic回归分析显示，mVCB的实施是降低VAP发病率的独立影响因素（OR0．57，95％C10．33～0．97，P=0．037）。结论VAP是增加机械通气患者死亡率的主要原因之一。对机械通气患者实施mVCB管理可以进一步降低VAP的发病率、减少机械通气时间、降低住院时间和住ICU时间。
Objective To evaluate the efficacy of ventilator care bundle involving supra-and sub-glottic secretion drainage （modified ventilator care bundle, mVCB） for preventing ventilator-associated pneumonia. Methods A retrospective chart review was performed for all mechanical ventilated patients （609 patients） in the Department of Emergency ＆ Critical Care Medicine of Shanghai Fifth People＇s Hospital from January 2011 to December 2014 before and after a modified ventilator care bundle implementation. Data collected included age, gender, diagnosis, development, length of mechanical ventila- tion, length of hospital stay, length of ICU stay. Rate of VAP, length of mechanical ventilation, length of hospital stay and length of ICU stay were compared between before and after mVCB implementation and VAP and non-VAP patients. Results Kaplan-Meier survival analysis showed that mortality of VAP patients was significantly higher than patients without VAP （P = 0.0049）. Compared with patients before mVCB implementation, rate of VAP was significantly lower after mVCB implementation （ 10.8 per 1000 ventilator days versus 6.4 per 1000 ventilator days, P = 0.0348）. Moreover, patients after mVCB imple- mentation had shorter length of hospital stay [ （26.8 ± 6.2） d vs. （28.6 ± 9.6） d, P = 0.0078 ] and shorter length of ICU stay [ （19.9±4.9）d vs. （21.3±7.5）d, P= 0.0063] Multivariate regression analysis showed that mVCB was an independent variable that could reduce the development of VAP （OR 0.57, 95% CI 0.33 -0.97, P = 0.037）. Conclusion VAP was one major cause that could increase mortality of me- chanical ventilated patients, mVCB implementation in mechanical ventilated patients could reduce the incidence of VAP, shorten length of mechanical ventilation, shorten length of hospital stay and ICU stay.
出处
《中国急救医学》
CAS
CSCD
北大核心
2016年第9期812-816,共5页
Chinese Journal of Critical Care Medicine
