纤维支气管镜上呼吸道管理预防呼吸机相关性肺炎的效果

发布时间：2018-04-16 19:28

本文选题：纤维支气管镜 + 上呼吸道分泌物吸引　；参考：《广东医学》2014年23期

【摘要】：目的观察纤维支气管镜行上呼吸道分泌物吸引对有创机械通气患者并发呼吸机相关性肺炎(VAP)的预防效果。方法选取2011年10月至2013年10月行机械通气的患者120例作为研究对象;将其分为观察组和对照组,对照组采用常规一次性吸痰管进行上呼吸道分泌物吸引,观察组采用在常规法基础上加用经鼻纤维支气管镜行上呼吸道分泌物吸引。观察两组患者第1周VAP发生率、第1周呼吸机支持时间、第1周一次性吸痰管使用数量、第1周鼻黏膜损伤率、总呼吸机支持时间、14 d成功脱机率、住院28 d病死率。结果对照组患者VAP的发生率为40.0%,而观察组患者VAP的发生率为13.3%,差异有统计学意义(P0.05),观察组机械通气时间、14 d成功脱机率、住院28 d病死率及鼻黏膜损伤发生率与对照组比较差异有统计学意义(P0.05)。结论按需有效吸引上呼吸道分泌物对呼吸机相关性肺炎的预防十分关键,经鼻纤维支气管镜上呼吸道分泌物吸引能明显降低机械通气患者VAP的发生率,缩短呼吸机支持时间,增加14 d成功脱机率,减少住院28 d病死率、第1周一次性吸痰管使用数量及鼻黏膜的损伤率,值得临床应用推广。
[Abstract]:Objective to observe the preventive effect of bronchofiberscope suction of upper respiratory tract secretion on VAPs in patients with ventilator associated pneumonia (VAP) after invasive mechanical ventilation.Methods 120 patients undergoing mechanical ventilation from October 2011 to October 2013 were divided into observation group and control group.The observation group was treated with nasal fiberoptic bronchoscope to attract the upper respiratory tract secretion on the basis of routine method.The incidence of VAP in the first week, the time of ventilator support in the first week, the number of disposable sputum suction tubes in the first week, the rate of nasal mucosal injury in the first week, the total ventilator support time and the successful weaning rate in 14 days were observed in both groups. The fatality rate was 28 days in hospital.Results the incidence of VAP in the control group was 40.0 and the incidence of VAP in the observation group was 13.30.The difference was statistically significant (P 0.05). The mechanical ventilation time of the observation group was 14 days and the successful weaning rate was 14 days.The fatality rate and the incidence of nasal mucosal injury were significantly higher than those of the control group (P 0.05).Conclusion it is very important for the prevention of ventilator-associated pneumonia to attract the secretion of upper respiratory tract on demand. The suction of the secretion of upper respiratory tract through nasal fiberoptic bronchoscopy can obviously reduce the incidence of VAP and shorten the time of ventilator support in patients with mechanical ventilation.It is worthy of clinical application to increase the successful weaning rate of 14 days, to reduce the fatality rate of 28 days in hospital, to use the disposable sputum suction tube in the first week and to damage the nasal mucosa.
【作者单位】：海南省人民医院重症医学科;
【分类号】：R563.1

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