集束化治疗颅脑疾病VAP预后价值的临床分析

发布时间：2019-04-17 05:29

【摘要】：目的：探讨集束化治疗措施对颅脑疾病患者呼吸机相关性肺炎预后的价值。方法：选择2010年9月-2012年3月期间入住我院ICU颅脑疾病的机械通气患者72例，随机分为对照组（实施常规治疗）35例及实验组（实施集束化治疗）37例。两组共同给予常规治疗，包括（1）原发病的治疗；（2）保护重要脏器功能；（3）尽量保持患者床头抬高，防止坠积性肺炎的发生；（4）合理使用抗生素；（5）每天进行撤机评估，尽早撤机拔管；（6）防止深静脉血栓；（7）减少院内交叉感染；（8）加强病区及仪器监管。除以上治疗外，，实验组包括：（1）每隔6小时交替给予2%氯已定溶液与4%碳酸氢钠清洁口咽部；（2）每日应用纤维支气管镜可视化吸痰，保持气道清洁干净；（3）根据监测患者具体血糖，给予泵入胰岛素控制血糖不高于10mmol/L；（4）给予患者泵人咪达唑仑和吗啡镇静镇痛，并每天实施1次唤醒计划，尽量减少镇静镇痛时间。比较实验组与对照组在ICU住院时间，ICU住院费用及患者28天死亡率方面之间的差异。结果：实验组ICU住院时间11.93±6.25天，对照组ICU住院时间18.08±7.53天(P=0.002)。试验组ICU住院的费用试验组:6.87±3.25万元，对照组:9.58±3.82万元(P=0.007)。结论：集束化治疗措施能够明显减少颅脑疾病呼吸机相关性肺炎患者的ICU住院时间、住院费用，但不能降低患者的28天死亡率。集束化治疗措施的作用是值得肯定的。
[Abstract]:Objective: to investigate the prognostic value of cluster therapy for ventilator-associated pneumonia in patients with craniocerebral diseases. Methods: 72 patients with ICU craniocerebral diseases admitted to our hospital from September 2010 to March 2012 were randomly divided into two groups: control group (n = 35) and experimental group (n = 37). The patients were divided into two groups: control group (n = 35) and experimental group (n = 37). The two groups were given routine treatment, including (1) primary treatment, (2) protection of important organ function, (3) keeping the bedhead of patients as high as possible to prevent the occurrence of falling pneumonia, (4) rational use of antibiotics, and (2) protection of the function of vital organs, (4) rational use of antibiotics. (5) to carry out daily weaning assessment and remove the catheter as soon as possible; (6) to prevent deep venous thrombosis; (7) to reduce hospital cross-infection; and (8) to strengthen the supervision of disease areas and instruments. In addition to the above treatment, the experimental group included: (1) 2% chlorhexidine solution and 4% sodium bicarbonate were given alternately every 6 hours to clean the oropharynx, (2) using fiberoptic bronchoscope to visualize sputum suction every day to keep the airway clean and clean. (3) according to the monitoring of specific blood glucose, insulin was given to control blood glucose of no more than 10 mmol / L; (4) midazolam and morphine were given to pump patients with sedative analgesia, and a wake-up plan was carried out once a day to reduce sedative and analgesic time as much as possible. The differences in hospitalization time of ICU, hospitalization cost of ICU and mortality of 28 days between the experimental group and the control group were compared between the experimental group and the control group. Results: the hospitalization time of ICU in experimental group was 11.93 卤6.25 days, and that of ICU in control group was 18.08 卤7.53 days (P < 0.002). The cost of ICU hospitalization in the experimental group was 6.87 卤32,500 yuan in the test group and 9.58 卤38,199 yuan in the control group (P < 0.007). Conclusion: cluster therapy can significantly reduce the hospitalization time and cost of ventilator-associated pneumonia (ICU) in patients with craniocerebral diseases, but it can not reduce the 28-day mortality of the patients. The effect of cluster therapy is commendable.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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