ICU患者采用改良呼吸机相关肺炎集束化治疗的临床价值分析

摘要

Objective To investigate the clinical effect of improved ventilator associated pneumonia cluster treatment in ICU patients. Methods 202 cases of ICU patients treated in our hospital from January 2011 to December 2013 were selected and randomly divided into control group (100 cases) and treatment group (102 cases). The control group was treated with conventional therapy, while the treatment group was given improved ventilator associated pneumonia cluster therapy. The mechanical ventilation time, hospital stays, hospitalization costs, morbidity and mortality of ventilator associated pneumonia (VAP) in two groups were observed and compared. Results The mechanical ventilation time, hospitalization time and hospitalization costs of patients in treatment group was (10.7±2.1) d, (12.5±4.6) d and (6.45±1.98) ten thousand yuan respectively, less than (13.4±3.2) d, (16.8±5.3) d and (8.50±2.12) ten thousand yuan of patients in control group, with statistical difference (P<0.05). After treatment, patients in treatment group had VAP in 9 cases (morbidity:8.82%), and 5 cases died with the mortality being 55.56%; patients in control group had VAP in 29 cases (morbidity: 29.00%), including 5 deaths (mortality:72.14%);the VAP morbidity of treatment group was lower than that of control group, with statistical difference (P<0.05), but the VAP mortality of two groups had no statistical difference (P>0.05). Conclusions Cluster treatment can obviously reduce the incidence of VAP in the treatment of ICU patients, and has specific value in reducing the VAP infection, mechanical ventilation time, rehospitalization rate and hospitalization costs.%目的：探讨改良呼吸机相关肺炎集束化治疗对ICU患者的临床治疗效果。方法选取2011年1月至2013年12月入住我院重症监护病房的202例患者作为研究对象，将其随机分为对照组(100例)和治疗组(102例)。对照组患者采用常规治疗，治疗组患者在常规治疗的基础上给予改良呼吸机相关肺炎集束化治疗，观察比较两组患者机械通气时间、住院时间、住院费用以及呼吸机相关性肺炎(VAP)的发病率和病死率。结果治疗组患者机械通气时间、住院时间和住院费用分别为(10.7±2.1) d、(12.5±4.6) d和(6.45±1.98)万元，均显著少于对照组的(13.4±3.2) d、(16.8±5.3) d和(8.50±2.12)万元，差异具有统计学意义(P<0.05)。治疗后，治疗组患者发生VAP 9例，发病率为8.82%，其中病死5例，病死率为55.56%；对照组患者发生VAP 29例，发病率为29.00%，其中病死21例，病死率为72.14%；治疗组VAP发病率显著低于对照组，差异有统计学意义(P<0.05)，但两组VAP病死率相比并无显著差异(P>0.05)。结论采取集束化治疗ICU患者能明显降低VAP的发生率，说明集束化治疗对降低呼吸机相关性肺炎感染及缩短上机时间、降低再次住院率、减少医疗费用等有明确临床价值。