摘要
目的比较传统气管切开插管、带有引流管的气管切开插管与带有冲洗引流管的气管切开插管在改善呼吸机相关性肺炎(VAP)发生率及其预后方面的作用。方法纳入2010年7月至2012年9月入院治疗需要接受气管切开插管的300例患者,按照1:2:2的比例随机分配到传统气管切开插管组(n=60)、带有引流管的气管切开插管组(n=120)和带有冲洗引流管的气管切开插管组(n=120)。观察3组患者在机械通气时间、VAP发生率、气管切开后VAP发生时间、ICU住院时间、28 d病死率以及总住院费用等方面的差异。结果传统组、引流管组和冲洗引流管组患者在机械通气时间[(11.3±3.2)d、(10.1±2.7)d和(8.4±2.1)d,P<0.01]、VAP发生率[(35.4±8.3)%、(31.5±9.4)%和(22.7±6.8)%,P<0.01]、气管切开后VAP发生时间[(4.5±1.2)d、(5.4±1.2)d和(7.2±1.9)d,P<0.01]、ICU住院时间[(14.4±4.2)d、(12.6±3.4)d和(9.3±2.8)d,P<0.05]上差异均有统计学意义,冲洗引流管组明显优于其他两组。结论应用带有冲洗引流管的气管切开插管有利于清除气囊上滞留物,方法安全、简便、经济、实用,可有效地预防VAP的发生并改善其预后。
Objective To compare the efficacy of conventional tracheotomy tube, tracheotomy tubewith a drainage tube, and tracheotomy tube with a washing and a drainage tube on the prevention andprognosis of ventilator associated pneumonia （ VAP） .？Methods 300 patients were divided randomly intothree groups with the ratio of 1 ∶2 ∶2 to receive different tracheotomy tube treatment, ie. Group A（ conventional tracheotomy tube group, n =60） , group B （ tracheotomy tube with a drainage tube group, n =120） , group C （ tracheotomy tube with a washing and a drainage tube group, n = 120） . The duration ofmechanical ventilation, the incidence rate of VAP, the average time between tracheotomy and occurrence ofVAP, the length of ICU stay, 28 day mortality rate and total cost in hospital were compared among threegroups.？Results Significant differences were found between three groups in the duration of mechanicalventilation （ 11. 3 ±3. 2 days, 10. 1 ±2. 7 days and 8. 4 ±2. 1 days, respectively, P 〈 0. 01） , the incidencerate of VAP （ 35. 4% ±8. 3% , 31. 5% ±9. 4% and 22. 7% ±6. 8% , respectively, P 〈 0. 01） , the averagetime between the tracheotomy and the occurrence of VAP （ 4. 5 ±1. 2 days, 5. 4 ±1. 2 days and 7. 2 ±1. 9days, respectively, P 〈0. 01） , and the length of ICU stay （ 14. 4 ±4. 2 days, 12. 6 ±3. 4 days and 9. 3 ±2. 8days, respectively, P 〈 0. 05） , with the group C demonstrating the lowest VAP incidence rate and bestprognosis.？Conclusion Tracheotomy tube with a washing and a drainage tube is a safe and cost effectivemethod to prevent VAP and improve its clinical outcome.
出处
《中国呼吸与危重监护杂志》
CAS
2013年第6期564-567,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
气管切开插管
机械通气
呼吸机相关性肺炎
Tracheotomy
Mechanical ventilation
Ventilator associated pneumonia
