人工气道关联与呼吸机相关性肺炎的风险分析及护理干预策略

摘要

目的：分析建立不同性质人工气道引发呼吸机相关性肺炎的风险，并观察人工气道护理对降低该风险的作用。方法：154例急危重症呼吸衰竭患者随机分为切开组和插管组各77例。切开组实施气管切开机械通气，插管组实施气管插管机械通气，两组均实施人工气道护理，包括气道护理、体位护理及口腔护理三个方面来进行。比较两组机械通气时间、ICU 入住时间、呼吸机相关性肺炎发生率。而后根据观察及菌培养结果统计两组呼吸机相关性肺炎的发病诱因。结果：插管组其机械通气时间、ICU 入住时间及呼吸机相关性肺炎发生率均显著少于切开组（ P ＜0.05）。插管组误吸导致呼吸机肺炎的几率显著低于切开组（P ＜0.05）。两组铜绿假单胞菌及白色念珠菌感染诱发呼吸机肺炎几率差异无统计学意义（ P ＞0.05），插管组其金黄色葡萄球菌诱发呼吸机肺炎几率显著高于切开组（ P ＜0.05）。结论：呼吸机相关性肺炎应用气管切开后的诱发风险比气管插管更显著，而实施人工气道护理能够有效地防控呼吸机相关性肺炎的发生。%Objective To establish the risk of ventilator associated pneumonia caused by different properties of artificial air-way,and to observe the effect of artificial airway care on reducing the risk of ventilator associated pneumonia. Method 154 pa-tients with acute respiratory failure were randomly divided into incision group 77 cases and intubation group 77 cases. Incision group of tracheotomy for mechanical ventilation,intubation group implementation of tracheal intubation and mechanical ventila-tion,two groups were implemented in artificial airway nursing,including airway nursing,postural care and oral care three as-pects. Comparison of two groups of mechanical ventilation time,ICU stay time,ventilator associated pneumonia incidence. Then according to the observation and culture results of two groups of patients with ventilator associated pneumonia. Results The time of mechanical ventilation,ICU stay and the incidence of ventilator associated pneumonia in the intubation group were significantly less than that in the incision group(P < 0. 05). The chance of aspiration in the intubation group was significantly lower than that in the incision group(P < 0. 05). Two groups of Pseudomonas aeruginosa and Candida albicans infection induced ventilator - as-sociated pneumonia rates had no significant difference(P > 0. 05),the Staphylococcus aureus ventilation induced pneumonia risk in the intubation group was significantly higher than that in the incision group(P < 0. 05). Conclusion Ventilator associated pneumonia is more significant than endotracheal intubation after tracheotomy,and the implementation of artificial airway care can effectively control the occurrence of ventilator associated pneumonia.