不同声门下吸引方式在预防呼吸机相关性肺炎中的应用及对气道黏膜的影响

目的 比较两种不同声门下吸引方式对呼吸机相关性肺炎（VAP）的预防效果及对气道黏膜的影响.方法 将136例机械通气患者按随机数字表法分为持续性声门下吸引（CASS）组及间歇性声门下吸引（IASS）组,每组68例.比较两组VAP的发生率、导管气囊上分泌物引流量及隐血阳性率,观察两组的预后.结果 IASS组与CASS组气道黏膜分泌物引流量比较差异无统计学意义（P＞ 0.05）,而IASS组分泌物隐血阳性率为17.6％（12/68）,显著低于CASS组的35.3％（24/68）,差异有统计学意义（P＜0.05）.两组发生VAP时间、早发性及晚发性VAP发生率比较差异均无统计学意义（P＞0.05）.IASS组与CASS组机械通气时间、ICU住院时间以及病死率比较差异均无统计学意义（P＞0.05）.结论 IASS与CASS对VAP的预防作用无差别,但IASS可显著减轻机械通气患者气道黏膜的损伤,值得进一步推广.

Application of different subglottic attraction in the prevention of ventilator-associated pneumonia and their affect on the airway mucosa

Objective To compare the application of two different subglottic attraction in the prevention of ventilator-associated pneumonia and their affect on the airway mucosa.Methods One hundred and thirty-six patients with mechanical ventilation were divided into continue aspiration of subglottic secretions （CASS） group and intermittent aspiration subglottic secretions （IASS） group by random digits table method with each 68 cases.The incidence rate of VAP,secretions volume,occult blood positive rate of secretions and prognosis between 2 groups were compared.Results There was no statistical difference in secretions volume between IASS group and CASS group （P 〉 0.05）.The occult blood positive rate of secretions in IASS group was significantly lower than that in CASS group 17.6% （12/68） vs.35.3%（24/68）],there was statistical difference （P 〈 0.05）.There were no statistical differences in the incidence time of VAP and incidence rate of VAP between 2 groups （P〉 0.05）.There were no statistical differences in the time of mechanical ventilation,time of ICU and mortality between IASS group and CASS group （P 〉 0.05）.Conclusion IASS and CASS has similar prevention on VAP,but IASS can significantly reduce the damage of mechanical vetilation on airway mucosa,which is worthy of further promotion.