呼吸机相关性肺炎发生率与镇静治疗的相关性研究

发布时间：2018-02-09 13:10

本文关键词： 呼吸机相关性肺炎镇静治疗相关因素　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景呼吸机使用是ICU患者抢救治疗的重要方法之一,应用呼吸机后常见并发症是呼吸机相关性肺炎,呼吸机相关性肺炎的发生不仅延长患者的住院时间,而且还是死亡的重要因素之一。在行机械通气过程中,患者常常出现烦躁不适、人机对抗等,往往需要使用镇静药物渡过机械通气期,但长时间镇静抑制了患者的咳嗽反射,影响气道分泌物清除,增加肺部感染的危险,因此,呼吸机相关性肺炎的发生与镇静治疗有密切关系。目前,ICU普遍存在不恰当的镇静,如何达到理想的镇静是困扰临床的重要课题。研究目的探讨重症监护室机械通气患者呼吸机相关性肺炎(VAP)发生与镇静治疗的相关因素,为机械通气患者合理应用镇静药提供指导,从而预防镇静剂带来的各种并发症,通过改善镇静策略,降低VAP的发生,降低病死率。研究方法本研究采用回顾性调查分析某三甲医院ICU 2014年7月-2016年6月行机械通气同时使用镇静药的218例患者的临床资料,呼吸机应用时间超过48h,且机械通气前无肺部感染,全部使用静脉持续泵入丙泊酚或力月西及采用RASS镇静评分。临床护理评估:血压、心率、血氧饱和度、呼吸等。根据入选标准和排除标准确定研究对象,首先在某三甲医院ICU电脑系统的护士工作站输入“呼吸机铺助呼吸”,时间选定在2014年7月至2016年6月,共检出571例机械通气患者,按设定条件“行机械通气超过48h患者”纳入研究对象,初步筛选出行机械通气超过48h患者302例,再按条件“行机械通气同时使用镇静药物患者”及剔除干扰项和明显不符合纳人标准的患者,最后筛选出行机械通气同时使用镇静药物的患者218例,统计218例机械通气患者总的镇静时间,镇静评分,机械通气时间,住ICU时间。以是否发生VAP进行分组,发生VAP为观察组,未发生VAP为对照组,比较两组患者在镇静时间、镇静评分、机械通气时间、住ICU时间的差异。研究结果VAP发生情况:218例机械通气患者中61例发生VAP(27.98%)、157例未发生VAP(72.02%)。入科时两组患者年龄、性别、心率、呼吸频率、平均动脉压、急性生理与慢性健康评分,差异无统计学意义(P0.05)。两组患者在预防呼吸机相关性肺炎集束化策略措施是一致的,所以两组具有可比性。观察组61例患者总的镇静时间为7.51±7.86天,镇静评分为-2.69±1.09分,机械通气时间为8.52±17.11天,住ICU时间24.44±21.93天,对照组157例患者总的镇静时间为3.83±2.91天,镇静评分为-1.22±1.52分,机械通气时间为6.47±5.70天,住ICU时间11.63±7.49天。两组差异有显著统计学意义(P0.01)。研究结论本文通过研究机械通气同时使用镇静药的218例患者的临床资料,分析机械通气患者VAP发生与镇静治疗的相关因素。通过研究表明机械通气患者镇静时间、深度与VAP发生具有相关性,从而在临床上为机械通气患者行镇静治疗时如何降低VAP的发生提供了依据,通过在镇静策略上进行改进,降低VAP的发生率。
[Abstract]:On the background of the use of ventilator is one of the important methods for patients with ICU treatment, application of respirator is a common complication after ventilator-associated pneumonia, the incidence of ventilator-associated pneumonia not only prolonged hospitalization or death, and one of the important factors. In the process of mechanical ventilation, patients often appear irritability discomfort, man-machine confrontation, often need to use sedative drugs through mechanical ventilation, but long time sedation suppresses cough reflex in patients with the effect of airway secretion clearance, increase the risk of pulmonary infection, therefore, has a close relation with the sedative treatment of respiratory machine related pneumonia. At present, ICU is not appropriate sedation, how to achieve the ideal of sedation is an important subject of clinical problems the study. Objective to investigate the mechanical ventilation in ICU patients with ventilator-associated pneumonia (VAP) and sedative treatment occurred The related factors, to provide guidance for the reasonable application of sedative drugs in patients with mechanical ventilation, and the prevention of complications caused by improving sedation, sedation strategies, reduce the incidence of VAP, reduce the mortality rate. Methods in this study 218 cases of investigation and analysis of a hospital in ICU July 2014 -2016 year in June for mechanical ventilation and the use of sedative drugs the patients, ventilator time more than 48h, and before mechanical ventilation without pulmonary infection, all of the use of intravenous infusion of propofol or midazolam and the RASS sedation score. Clinical nursing assessment: blood pressure, heart rate, oxygen saturation, respiration and so on. According to the inclusion criteria and exclusion criteria to determine the object of study, first enter nurse a hospital ICU workstation computer system aided ventilator breathing ", the selected time in July 2014 to June 2016, there were 571 cases of patients with mechanical ventilation According to the conditions set, "mechanical ventilation for more than 48h patients enrolled in the study, preliminary screening of travel mechanical ventilation for more than 302 cases of 48h patients, according to the condition of mechanical ventilation and the use of sedative drugs in patients with" and eliminate interference term and obviously does not meet the inclusion criteria of patients, the screening of 218 patients with mechanical ventilation and travel the use of sedative drugs, 218 cases of patients with mechanical ventilation the total sedation time, sedation score, mechanical ventilation time, ICU stay time. According to whether the occurrence of VAP group, VAP in the observation group, without VAP as control group, compared two groups of patients in the sedation time, sedation score, duration of mechanical ventilation, the difference to live the time of ICU. Results: 218 cases of VAP patients with mechanical ventilation in 61 cases of VAP (27.98%), 157 cases without VAP (72.02%). The patients of the two groups, age, gender, heart rate, respiratory rate, mean arterial pressure , acute physiology and chronic health score, the difference was not statistically significant (P0.05). The two groups of patients are consistent in the prevention of ventilator-associated pneumonia cluster strategy measures, so the two groups were comparable. Observe the sedation time of patients with the total group of 61 patients was 7.51 + 7.86 days, sedation score for -2.69 + 1.09, mechanical ventilation time was 8.52 + 17.11 days, ICU stay time 24.44 + 21.93 days, with the total sedation time control group of 157 cases was 3.83 + 2.91 days, sedation score for -1.22 + 1.52, the duration of mechanical ventilation was 6.47 + 5.70 days, ICU stay time 11.63 + 7.49 days. There was significant difference between the two groups (P0.01). The clinical data of 218 patients with the conclusion of the study through the study of mechanical ventilation and the use of sedative drugs, analysis of related factors and sedative treatment of patients with VAP mechanical ventilation. Patients with mechanical ventilation. The time that through research, depth and VAP has occurred Therefore, it can provide a basis for reducing the incidence of VAP in patients undergoing mechanical ventilation during sedation treatment. We should improve the sedation strategy to reduce the incidence of VAP.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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