ICU 呼吸机相关性肺炎综合预防及发病机制的研究

目的探讨综合预防措施在改善会厌清洁度，减少会厌部真菌定植，从而减少呼吸机相关性肺部真菌感染中的价值。方法选取2010年10月～2013年12月梧州市人民医院ICU58例气管插管患者，将其分为干预组（33例）和对照组（Z5例）。干预组强化医护人员手卫生管理；采取30°-45°半卧位，给予带有声门下分泌物引流功能的气管导管间歇吸引＋鼻饲胃动力药多潘立酮；强化口腔护理、冲注法会厌部保洁，纤支镜下会厌冲洗。对照组仅做常规口腔护理。以干预后10d作为疗效评价时间点，比较两组患者的会厌清洁度及会厌部定植真菌的变化。结果综合干预措施可明显改善会厌清洁度，经综合措施治疗后干预组会厌清洁度好转率为63．64％（经口插管）和83．33％（经鼻插管），干预组会厌清洁度好转率与对照组比较，差异有统计学意义（P〈0．05）。综合措施治疗后干预组会厌部真菌定植阴转率达75．00％（经口插管）和88．89％（经鼻插管），干预组真菌阴转率与对照组比较，差异有统计学意义（P〈0．05）。结论保持、改善会厌清洁度，可明显降低气管插管患者继发呼吸机相关性肺部真菌感染之风险。

Study of integrated prevention and pathogenesis about ICU ventilator associated pneumonia

Objective To study the value of the comprehensive prevention measures in improving the epiglottis cleanliness and reducing the fungi colonize in epiglottis, to reduce fungus infection of ventilator associated pneumonia. Methotis From October 2010 to December 2013, in People＇s Hospital of Wuzhou City, 58 patients with tracheal intubation were selected and divided into intervention group （33 cases） and control group （25 cases）. The intervention group were given the strengthened medical staff hand hygiene management; 30°-45° fowler position, subglottic secretion drainage endotracheal tube for subglottic secretion intermittent drawing ＋ Pan Li ketone by nasal feeding; the strengthened oral care, injection method of epiglottis cleaning and bronchoscopy microscopic epiglottis flushing. The control group were given the regular oral care. 10 days after the treatment was as a curative effect evaluation time point, the epiglottis cleanliness and the change of the epiglottis fungi colonize of two groups were compared. Results The epiglottis cleanliness was significantly improved after the comprehensive prevention measures, the epiglottis cleanliness improving rate of the intervention group were 63.64% （oral intubations） and 83.33% （nasal intubation）, compared with those of the control group, the differences were statistically significant （P 〈 0.05）. The fungi colonize negative conversion rate of the intervention group were 75.00% （oral intubations） and 88.89% （nasal intubation）, compared with those of the control group, the differences were statistically significant （P 〈 0.05）. Conclusion Maintaining, improving the cleanliness of epiglottis can reduce the secondary ventilator associated risk of pulmonary fungus infection obviously.