摘要
目的:探讨持续声门下吸引术(CASS)降低老年患者呼吸机相关性肺炎(VAP)的效果。方法:选择兴山县人民医院2021年2月—2022年2月收治的86例在重症监护病房(ICU)行机械通气治疗的老年患者,随机分为对照组(n=43)和观察组(n=43)。对照组采用常规气管导管,应用吸痰管进行鼻咽部滞留物清除;观察组采用CASS术,将可冲洗、引流的气管导管连接负压吸引装置进行声门下滞留物持续引流、清除处理。对比两组患者VAP发生率、滞留物菌群培养情况、机械通气时间、人工气道留置时间、ICU入住时间、住院时间。结果:观察组VAP总发生率(13.95%)显著低于对照组(51.16%)(P<0.05);观察组革兰阳性菌发现率(13.95%)显著低于对照组(41.86%)(P<0.05),两组革兰阴性菌及真菌发现率比较差异无统计意义(P>0.05);观察组的机械通气时间、人工气道留置时间、ICU入住时间及住院时间均显著少于对照组(P<0.05)。结论:CASS术可降低ICU老年患者VAP的发生率,抑制革兰阳性菌增殖,并能明显缩短老年患者机械通气时间、人工气道留置时间、ICU入住时间及住院时间,临床疗效确切。
Objective:To investigate the effect of continuous subglottic aspiration(CASS)in reducing ventilator-associated pneumonia(VAP)in elderly patients.Methods:All 86 elderly patients in intensive care unit(ICU)treated with mechanical ventilation in Xingshan People's Hospital from February 2021 to February 2022 were randomly divided into control group(n=43)and observation group(n=43).The control group was treated with conventional endotracheal tube,and nasopharynx retention was removed with sputum suction tube.The observation group was treated with CASS,and the washable and draining endotracheal tube was connected with negative pressure suction device for continuous drainage of subglottic retention The incidence of VAP,the culture of residual bacteria,the time of mechanical ventilation,artificial airway retention time,the time of ICU admission and the time of hospitalization were compared between the two groups.Results:The total incidence of VAP in the observation group(13.95%)was significantly lower than that in the control group(51.16%)(P<0.05).The detection rate of Gram-positive bacteria in the observation group(13.95%)was significantly lower than that in the control group(41.86%)(P<0.05).There was no significant difference in the detection rate of gram-negative bacteria and fungi between two groups(P>0.05).The time of mechanical ventilation,artificial airway retention time,ICU stay and hospital stay in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion:Cass can reduce the occurrence of VAP in elderly patients in ICU,inhibit the proliferation of Gram-positive bacteria,and significantly shorten the mechanical ventilation time,artificial airway retention time,ICU admission time and hospitalization time of elderly patients.The clinical effect is accurate.
作者
王小平
WANG Xiaoping(The People's Hospital of Xingshan,Xingshan 443700,China)
出处
《临床医药实践》
2023年第9期669-671,693,共4页
Proceeding of Clinical Medicine
关键词
气管插管
声门下吸引术
呼吸机相关性肺炎
endotracheal intubation
continuous subglottic aspiration
ventilator associated pneumonia
