气囊上滞留物引流预防老年机械通气患者呼吸机相关肺炎的研究

摘要

目的探讨气囊上滞留物引流能否预防老年机械通气患者呼吸机相关肺炎（VAP）的发生，并比较持续与体位改变前后引流预防 VAP 效果及患者耐受性的差异。方法选取在 ICU 进行机械通气治疗、年龄＞65岁的老年患者120例，按随机数字表法分成对照组（A 组）、持续气囊上滞留物引流组（B 组）、体位改变前后气囊上滞留物引流组（C 组），每组各40例。所有患者均接受可冲洗式气管套管治疗，B 组在常规治疗的基础上给予不间断气囊上滞留物引流，C 组患者每次体位改变前后予气囊上滞留物引流。观察3组患者 VAP 的发生率、VAP 病原菌分布、ICU 停留时间，并比较 B、C 组患者耐受性的差异。结果3组患者 VAP 病原菌以 G-菌为主（61.6%），其中铜绿假单胞菌及鲍曼复合醋酸钙不动杆菌占多数；其次为 G+菌（22.3%），以金黄色葡萄球菌为主；真菌占16.1%，以白色念珠菌为主。3组患者 VAP 的发生率分别为75.2%、50.0%、40.0%，ICU 停留时间分别为（13.3±4.2）、（10.9±4.0）、（10.0±3.0）d。B 组与 C 组 VAP 的发生率较 A 组低，ICU 停留时间均较 A 组短，差异均有统计学意义,而 B 组与 C 组间的差异无统计学意义。B 组出现少许血性引流物2例，明显呛咳1例；C 组患者未出现不耐受情况。结论老年机械通气患者使用气囊上滞留物引流能够有效减少 VAP 的发生，缩短 ICU 停留时间，患者对体位改变前后气囊上滞留物引流的耐受性好，并发症少，临床操作简单，值得推广。%Objective To investigate the effects of subglottic secretion drainage on the incidence of ventilator-associated pneumonia (VAP) in elderly patients receiving mechanical ventilation. Methods One hundred and twenty elderly patients with mechanical ventilation in ICU were enrol ed in our study and divided randomly into three groups: group A (control group), group B (continuous subglottic secretion drainage ) and group C (subglottic secretion drainage when posture changed). The incidence of VAP, pathogenic bacteria, length of ICU stay, and the tolerance to treatment were compared among groups. Results Gram-negative bacteria accounted for 61.6% of VAP pathogens with Pseudomonas aeruginosa and Acinetobacter spp as most prevalent; Gram-positive bacteria accounted for 22.3% with Staphylococcus aureus as most prevalent; fungi accounted for 16.1% with Candida albicans as most common. The incidence of VAP in patients of group A, B and C was 75.2%, 50.0% and 40.0% (P<0.05) , the length of ICU stay was (13.3±4.2)d, (10.9±4.0)d and (10.0±3.0)d (P<0.05), respectively. The length of ICU stay in group B and group C was both shorter than that in group A, and the incidence of VAP in group B and group C was both lower than that in group A; meanwhile there was no significant difference of the incidence of VAP and the length of ICU stay between group B and group C. Airway bleeding in 2 case and intolerable cough in 1 case were discovered in group B, while no intolerable effects were observed in group C. Conclusion The subglottic secretion drainage reduces the incidence of VAP and the length of ICU stay in elderly patients receiving mechanical ventilation. Moreover, subglottic secretion drainage when posture changed is well performed and tolerated with fewer complications.