综合干预措施减少呼吸机相关性肺炎的发生率和上机时间

摘要

目的:探讨综合干预措施对呼吸机相关性肺炎( VAP )的临床效果,并观察患儿上机时间及其预后,为临床干预提供依据. 方法:随机选择本院2012年1月至2013年12月诊治的重症肺炎患儿50例,均即使用呼吸机治疗,为实验组,采用综合干预措施. 选取2010年1月至2011年12月未采用综合干预措施的50例重症肺炎患儿为对照组. 主要观察两组患儿VAP 发生率、死亡率、排痰效果评分、上机时间、发生VAP时间、快速手消夜的消耗量及手卫生状况. 结果:实验组患儿VAP 发生率和死亡率分别为4.00%(2/50)和2.00%(1/50),低于对照组,差异具有统计学意义(P<0.05);实验组患儿发生VAP 时间为4.83±0.39d,长于对照组(P<0.05);实验组上机时间为4.25±0.13d,少于对照组(P<0.05);实验组患儿排痰效果评分为1.19±0.18分,低于对照组(P<0.05);实验组手消夜消耗量为120.53±7.21mL/d. 高于对照组,差异有统计学意义(P<0.05);实验组手菌落数为3.20±0.18cfu/cm3,低于对照组,差异有统计学意义(P<0.05);实验组住院时间为12.64±1.57d,少于对照组,差异有统计学意义( P<0.05). 结论:综合干预措施能够降低重症肺炎患儿VAP 发生率,具有较好的排痰效果,缩短患者上机时间和治疗时间,明显提高了医护人员手卫生状况,提高了干预效果.%Objective:To explore the clinical effect of comprehensive intervention measures for ventila-tor associated pneumonia ( VAP ) , and watch the children mechanical time and its prognosis, and provide the basis for clinical intervention.Method:50 children with severe pneumonia were randomly selected from January in 2012 to December in 2012, used breathing machine treatment, as the experimental group, using comprehensive intervention measures.50 cases of children with severe pneumonia were chosen from January to December in 2010, without using comprehensive intervention measures as the control group.To observe VAP incidence, mortality, expectoration drainage effect score, computer time and VAP occurrence time, quick snack of consumption and hand hygiene.Result:VAP incidence and mortality rates of the experimen-tal group were 4.00%( 2/50) and 2.00%( 1/50) , lower than the control group, the difference statistically significant ( P <0.05) .VAP happen time of experimental group was 4.83 ±0.39 d, more than the controlgroup (P <0.05).VAP mechanical time of the experimental group was 4.25±0.13 d, less than the control group ( P <0.05) .The expectoration drainage effect score of the experimental group was 1.19 ±0.18 points, lower than the control group ( P <0.05) .The hand snack consumption of the experimental group was 120.53 ±7.21 ml/d, more than that of control group, the difference was statistically significant (P <0.05).The hand colony count of the experimental group was 3.20 ±0.18 cfu/cm3, lower than the control group, the difference was statistically significant ( P <0.05) .The hospital stay time of the experimental group was 12.64 ±1.57d, less than the control group, the difference was statistically significant (P <0.05).Conclusion:Comprehensive intervention measures can reduce the incidence of VAP for children with severe pneumonia, and has good expectoration drainage effect .It can shorten the patient mechanical time and treatment time, and significantly improve the medical staff hand hygiene, improve the intervention effect.