间断声门下灌洗结合持续声门下吸引在经口气管插管患者预防呼吸机相关性肺炎中的作用.pdfVIP

• 22 • 中华护理杂志 2013 年 1 月第 48 卷第 l 期 Chin J Nurs ， J皿uary 2013 ,Vol 48 ,No .l 间断声门下灌洗结合持续声门下吸引在经口气管插管患者 预防呼吸机相关性肺炎中的作用 王莹马洁患彩红宋文静 [摘要] 目的 观察经口气管插管患者应用间断声门下灌沈结合持续声门下吸引对呼吸机相关性肺炎的影响。方法 对入 住ICU预期机械通气(Mechanical ventilation ,MV) 48h的患者60例，按经口气管插管机械通气时间顺序分为A纽、B纽和C纽，每 纽20例。 A纽采用持续声门下吸引的方法，B纽采用持续声门下吸引结合间断声门下灌洗的方法，C纽采用常规吸引方法。 3纽患 者均在MV， 50h 、4d、7d采用支气管镜留取下呼吸道分泌物，同步留取声门下滞留物进行细菌培养，呼吸机相关性肺炎(VAP) 、声 门下引流的量及引流管发生堵塞的情况进行统计和观察。结果 A纽患者VAP及4d 内 VAP的发生率分别为38.91J岛、 16.7% ， B纽 为33.3%、 1 1.1%， C纽为73.7%、 47.4%0 B纽声门下引流总量明显多于A组，B组和M且声门下引流总量明显多于C纽。 A纽患者引流 27.8% ， C纽为42.1% ， B纽未发生引流管堵塞的现象。结论 间断声门下灌洗结合持续声门下吸引可以降低 管堵塞的发生率为 附加管堵塞的发生卒，降低VAP的发生率。 [关键词] 灌洗; 扮吸; 肺炎，呼吸机相关性; 声门下 EtJect of inten副tteot irriga筒。10 combined with coo伽uous aspira创00 of subglottic secretioo on the preventioo of ven创ator-associa俗d poeumonialWANG Ying ,MA Jie ,HUI Cai-hoog ,SONG Weo-jing [Abstract] Objective To evaluate the effect of intermittent irrigation combined wi由 continuous aspiration of 8ubglottic secretion on the prevention of ventilator-associated pneumonia(VAP). Methods Sixty ICU patients with mechanical ventilation were divided into 3 groups ,20 cases in each group. The patients in group A received continuous aspiration of subglottic secretion ;the patients in group B received intermittent irrigation combined with continuous aspiration of subglottic secretion; the patients in group C received conventional treatment. The specimen of respiratory tract secretion and residual subglottic secretion were taken for bacterial culture at 50 hours ,4 days and 7 days after mechanical ventilation. Moreover ,the incidence of VAP ,the volume of subglottic drainage and the incidence of obstruction of drainage tube were recorded. Results 币le total incidence of VAP and incidence of VAP at 4 .days after mechanical ventilation in group A was 38.9% and 16.7% , respective