密闭式吸痰对新生儿呼吸机相关性肺炎发生率的影响研究

目的：探讨密闭式吸痰（CSS）与开放式吸痰（OSS）对新生儿呼吸机相关性肺炎（ventilator-associated pneumonia ,VAP）发生率的影响,为临床选择最佳吸痰方式提供依据。方法选择2011年3月～2012年12月在我院新生儿重症监护病房（NICU ）经口行气管插管机械通气治疗患儿100例,随机分为CSS组（实验组）和OSS组（对照组）各50例,比较分析两组患者的呼吸机相关性肺炎发生率、病死率、住院时间、住院费用及菌群情况等。结果实验组呼吸机相关性肺炎发生率、病死率均低于对照组,住院时间短于对照组,两组患儿VAP发生率差异有显著意义（P＜0．05）,两组患儿呼吸道内培养出的菌株以革兰阴性菌为主,偶有真菌;OSS组的菌株种类杂、数量多。结论密闭式吸痰方法在降低新生儿呼吸机相关性肺炎中的效果优于开放式吸痰法,值得临床推广使用。     

两种气管内吸痰方式对 ICU患者呼吸机相关性肺炎的影响

目的：探讨两种气管内吸痰方式对ICU患者呼吸机相关性肺炎的效果。方法选取我院重症医学科（ ICU）收治的呼吸机相关性肺炎患者120例作为研究对象,随机分为观察组和对照组各60例。观察组采用密闭式气管内吸痰,对照组采用开放式气管内吸痰,比较两种气管内吸痰方式对呼吸机相关性肺炎的影响。结果吸痰后,观察组患者的下呼吸道支气管肺泡灌洗液细菌检出率均明显低于对照组,差异有统计学意义（ P＜0.05）;吸痰过程中,观察组血氧饱和度明显高于对照组,观察组呼吸机相关性肺炎的发生率为15％,明显低于对照组,差异均有统计学意义（ P＜0.05）。结论密闭式气管内吸痰方式可有效降低ICU患者呼吸机相关性肺炎的发生率,其效果优于开放式气管内吸痰方式,值得临床应用。     

两种吸痰方法对新生儿呼吸机相关性肺炎的影响

目的比较两种吸痰方法对新生儿呼吸机相关肺炎性(VAP)的影响,探讨更好的吸痰方法。方法通过对比研究方法,对密闭式吸痰法和开放式吸痰法用于某医院住院新生儿气管插管机械通气患儿吸痰的效果及其影响。结果 62例密闭式吸痰的患儿中,有14例发生了VAP,感染率为22.58%。59例开放式吸痰的患儿中,有29例发生了VAP,感染率为49.15%。两组患儿的VAP发生率均随机械通气时间的延长而升高。密闭式吸痰操作过程中,Sp O2下降发生率6.45%,呼吸道损伤发生率9.68%。开放式吸痰过程中,Sp O2下降发生率22.03%,呼吸道损伤发生率35.60%。结论密闭式吸痰法有利于预防VAP的发生,可降低呼吸道损伤,值得推广应用。     

密闭式吸痰发生呼吸机相关性肺炎的系统评价

目的比较密闭式吸痰与开放式吸痰在发生呼吸机相关性肺炎等并发症方面的差异。方法电子检索Cochrane图书馆(2007年第1期)、PubMed(1980～2007)、CBM(1980～2007)及CNKI(1980～2007)。手工检索《中华护理杂志》等,收集密闭式吸痰对比开放式吸痰发生呼吸机相关性肺炎等并发症的随机对照试验(RCT),并评价纳入研究的方法学质量。统计分析采用Cochrane协作网提供的RevMan4.2.8软件。结果共纳入5个RCT,包括739例患者。Meta分析结果表明,密闭式吸痰与开放式吸痰比较,两组呼吸机相关性肺炎发生率差异无统计学意义[RR=0.83,95%CI(0.50,1.37)],患者病死率差异无统计学意义[RR=1.05,95%CI(0.85,1.31)]。两种疗法形成总菌落数[RR=1.43,95%CI(0.80,2.53)]、SPP菌落数(不动杆菌属)[RR=2.87,95%CI(0.94,8.74)]和PSE菌落数(铜绿假单胞菌)[RR=1.46,95%CI(0.76,2.77)]差异均无统计学意义。两组患者机械通气及ICU住院时间差异也无统计学意义(P=0.06;P=0.55)。结论密闭式吸痰与开放式吸痰比较,两组发生呼吸机相关性肺炎、病死率、总菌落数、SPP和PSE菌落数量、机械通气及ICU住院时间均无差异。因本系统评价存在统计学效能的问题和研究中干预措施不尽相同,结论有待进一步确认,我们尚需更多设计严格的大样本随机对照研究以增加证据的强度。     

不同吸痰程序对新生儿呼吸机相关性肺炎的影响

目的：探讨不同的吸痰程序对新生儿呼吸机相关性肺炎（ VAP）发生率的影响。方法将172例接受经口无套囊气管插管机械通气治疗的新生儿随机分为实验组88例与对照组84例,实验组采用先使用一次性吸痰管吸口鼻腔后,再使用密闭吸痰系统吸气管内分泌物的吸痰程序,对照组采用先使用密闭吸痰系统吸气管内后,再使用一次性吸痰管吸口鼻腔分泌物的吸痰程序。结果实验组VAP的发生率为9.09％,显著低于对照组19.05％,差异有统计学意义（ P＜0.05）。结论采用先使用一次性吸痰管吸口鼻腔后,再使用密闭吸痰系统吸气管内分泌物的吸痰程序,可以有效降低新生儿VAP发生率。     

密闭式吸痰法联合机械通气对新生儿呼吸机相关性肺炎的临床效果

目的观察密闭式吸痰法联合机械通气治疗新生儿呼吸机相关性肺炎的疗效。方法选取本院新生儿重症监护病房行机械通气的80例新生儿作为研究对象,利用随机数表法分为2组,各40例。2组患儿均进行机械通气治疗,对照组采取常规吸痰治疗,观察组采取密闭式吸痰法进行治疗,对比2组动脉血气指标、并发症发生情况、病死率、住院时间、住院费用及菌群情况。结果治疗前,2组动脉氧分压[p(O_2)]及动脉血二氧化氮分压[p(CO_2)]水平差异无统计学意义(P 0. 05);治疗后,2组p(O_2)、p(CO_2)水平均显著改善,且观察组p(O_2)水平显著高于对照组,p(CO_2)显著低于对照组,差异有统计学意义(P 0. 05); 2组患儿颅内出血、气道损伤、气漏及病死率差异无统计学意义(P 0. 05);观察组呼吸机相关性肺炎发生率显著低于对照组,住院时间显著短于对照组,住院费用显著低于对照组,菌群数显著少于对照组,差异有统计学意义(P 0. 05);2组患儿病死率无显著差异(P 0. 05)。结论密闭式吸痰法联合机械通气可有效降低新生儿呼吸机相关性肺炎发生率,缩短患儿机械通气维持时间及住院时间,节约住院费用。     

密闭式吸痰法配合不同吸痰深度对呼吸机相关性肺炎发生的影响

目的 探讨密闭式吸痰法时不同吸痰深度对呼吸机相关肺炎(VAP)发生的影响.方法 将60例同期行机械通气的患者随机分为A、B、C 3组各20例,A组行密闭式吸痰配合浅吸痰,B组行密闭式吸痰配合深吸痰,C组接受密闭式吸痰配合改良吸痰法.结果 A组VAP发生率为50%,显著高于B组25%、C组20%,P＜0.05;B组患VAP的时间为行机械通气后(5.15±1.35)d与A组患VAP的时间比较,P＜0.05;C组发生VAP的时间为行机械通气后(8.20±2.26)d,与A、B组发生VAP的时间比较,P＜0.05;各组发生VAP患者中,临床肺部感染评分(CPIS)分值于插管后第5天开始A、B组明显高于C组,至第7天C组分值升高,与A组比较差:异无统计学意义.结论 密闭式吸痰法配合改良可以减少VAP的发生,且使发生时间延迟.     

两种吸痰方式对行气管插管机械通气患者呼吸机相关性肺炎的影响

目的:探讨两种吸痰方式对行气管插管机械通气患者呼吸机相关性肺炎的效果。方法:将120例行气管插管机械通气的患者随机分为研究组和对照组各60例,对照组患者常规吸痰,每隔2 h定时给予患者1～2 ml生理盐水湿化气道,并进行吸痰;研究组患者随时监视吸痰指征,当痰液达到Ⅲ度黏稠时应用1～2 ml生理盐水湿化气道后行吸痰处理。结果:研究组患者VAP发生率为26.67%,明显低于对照组(65.00%)(P<0.05);研究组吸痰间隔时间明显长于对照组(P<0.05)。结论:根据患者痰液浓度及吸痰指征进行吸痰操作,可大大减轻护理工作人员的时间,延长两次吸痰间隔时间,减少吸痰频次,减少人力和物力的消耗,提高工作效率。     

可吸痰式气管切开插管预防呼吸机相关性肺炎的效果观察

目的观察可吸痰式气管切开插管对预防呼吸机相关性肺炎（ventilato rassociated pneumonia,VAP）的临床价值。方法便利选取2010年1月至2012年1月在海军安庆医院ICU治疗的66例经气管切开行机械通气（mechanical ventila—tion,MV）患者为研究对象,按入院先后将其分为对照组（n=34）和观察组（n=32）。对照组患者使用一次性气管切开插管,观察组患者使用可吸痰式气管切开插管,观察两组患者VAP的发生率以及呼吸机停用的时间。结果 4d内,观察组患者VAP的发生率为12．5％,低于对照组的41．1％,差异有统计学意义（P〈0．05）;观察组MV使用时间明显短于对照组,差异有统计学意义（P〈0．05）。4d后,两组患者VAP的发生率分别为28．1％和35．3％,差异无统计学意义（P〉0．05）。结论应用可吸痰式气管切开插管可略低早发性VAP的发生率及MV的使用时间．但并不能隆低VAP的发生率。     

改良吸痰法防治呼吸机相关性肺炎的临床效果

目的探讨预防呼吸机相关性肺炎的有效吸痰方法。方法将80例患者按随机数字表法分为两组,对照组采用传统的吸痰方法,实验组采用改良的吸痰方法,即从吸痰体位、润滑程度、插管方法等方面加以改进。结果实验组呼吸机相关性肺炎发生率、病死率均低于对照组(P0.05);实验组患者机械通气时间、入住ICU时间及住院时间均较对照组缩短(P0.05)。结论改良吸痰方法有助于提高吸痰效果,减轻患者呼吸道损伤,减少呼吸机相关性肺炎的发生。     

Tracheal suction by closed system without daily change versus open system

Background

Tracheal suctioning costs are higher with a closed tracheal suction system (CTSS) than with an open system (OTSS), due to the need for complete daily change as recommended by the manufacturer. However, is it necessary to change the closed system daily?

Objective

To evaluate the tracheal suctioning costs and incidence of ventilator-associated pneumonia (VAP) using closed system without daily change vs OTSS.

Design

Prospective and randomised study.

Setting

An Intensive Care Unit in a university hospital.

Patients

Patients requiring mechanical ventilation.

Interventions

Patients were randomly assigned to CTSS without daily change or OTSS. We used a CTSS that allowed partial or complete change.

Measurements and results

There were no significant differences between both groups of patients (236 with CTSS and 221 with OTSS) in gender, age, diagnosis, APACHE-II score, mortality, number of aspirations per day, percentage of patients who developed VAP (13.9 vs 14.1%) or the number of ventilator-associated pneumonia per 1000 days of mechanical ventilation (14.1 vs 14.6). There were not significant differences in tracheal suctioning costs per patient/day between CTSS vs OTSS (2.3?±?3.7 vs 2.4?±?0.5 Euros; p?=?0.96); however, when length of mechanical ventilation was lower than 4?days, the cost was higher with CTSS than with OTSS (7.2?±?4.7 vs 1.9?±?0.6?Euros; p?p?Conclusion CTSS without daily change is the optimal option for patients needing tracheal suction longer than 4?days.     

A prospective,randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system

The objective of this study was to verify the incidence of nosocomial pneumonia in intubated and extended mechanically ventilated patients having endotracheal suctioning by an open vs. closed suction method aiming to decrease nosocomial pneumonia. Twenty-four (51.1%) patients received open-tracheal suction and 23 (48.9%) received closed-tracheal suction. The inclusion criteria were: surgical and medical patients older than 13 years, undergoing mechanical ventilation for more than 48 hours. Additional data were gathered using the Acute Physiology and Chronic Health Evaluation II, and details on smoking, alcoholism, diabetes mellitus, renal failure, previous lung disease, and previous use of antibiotics, steroids, H2 antagonists and antacids. Among the 24 patients having open-tracheal suction, 11 developed nosocomial pneumonia while of the 23 patients undergoing closed-tracheal suction, seven developed infection (P = 0.278). Risk factors for nosocomial pneumonia were not significantly different between the two groups. In the final logistical regression model the following variables remained: groups (open and closed) [odds ratio (OR) = 0.014; confidence interval (CI) = 0.001-0.416; P = 0.014] and use of prior antibiotics (OR = 2.297; CI = 1.244-4.242; P = 0.008). Use of a closed suction system did not decrease the incidence of nosocomial pneumonia when compared with the open system. The exogenous risk factors were the most important for acquiring this infection.     

Comparison of open and closed suction on safety,efficacy and nursing time in a paediatric intensive care unit

BackgroundEndotracheal suctioning (ETS) is one of the most common procedures performed in the paediatric intensive care. The two methods of endotracheal suctioning used are known as open and closed suction, but neither method has been shown to be the superior suction method in the Paediatric Intensive Care Unit (PICU).PurposeThe primary purpose was to compare open and closed suction methods from a physiological, safety and staff resource perspective.MethodsAll paediatric intensive care patients with an endotracheal tube were included. Between June and September 2011 alternative months were nominated as open or closed suction months. Data were prospectively collected including suction events, staff involved, time taken, use of saline, and change from pre-suction baseline in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO₂). Blocked or dislodged ETTs were recorded as adverse events.FindingsClosed suction was performed more often per day (7.2 vs 6.0, p < 0.01), used significantly less nursing time (23 vs 38 min, p < 0.01) and had equivalent rates of adverse events compared to open suction (5 vs 3, p < 0.23). Saline lavage usage was significantly higher in the open suction group (18% vs 40%). Open suction demonstrated a greater reduction in SpO₂ and nearly three times the incidence of increases in HR and MAP compared to closed suction. Reductions in MAP or HR were comparable across the two methods.ConclusionsIn conclusion, CS could be performed with less staffing time and number of nurses, less physiological disturbances to our patients and no significant increases in adverse events.     

新生儿呼吸机相关肺炎的临床分析

目的分析新生儿呼吸机相关性肺炎（VAP）的特点和危险因素,探讨降低VAP发病率的预防措施。方法采用回顾性调查手段,分析引起新生儿VAP的危险因素。结果新生儿VAP发病率为36.46%,新生儿VAP与胎龄、出生体质量、多次插管、机械通气时间和肺泡表面活性物质使用等有明显关系;主要病原菌为革兰氏阴性杆菌。结论早产儿、低出生体质量儿、多次插管、机械通气时间是新生儿VAP的危险因素,而肺泡表面活性物质使用是新生儿VAP的保护因素。采用对应措施和使用肺泡表面活性物质可以降低新生儿VAP发生率。     

开放与密闭式吸引系统对呼吸机相关性肺炎发生率的影响研究进展

综述了开放式吸痰系统(OSS)、密闭式吸痰系统(CSS)与呼吸机相关性肺炎(VAP)的关系以及对VAP发生率的影响,突出OSS、CSS的优越性.     

密闭式与开放式声门下冲洗吸引效果的对比研究

目的比较密闭式串联三通与开放式声门下冲洗吸引装置的效果。方法 2011年1月至2013年8月入住ICU行气管切开并机械通气患者120例,按行声门下冲洗的时间顺序分为A组和B组,A组采用开放式注射器冲洗方法,B组采用密闭式串联三通冲洗吸引装置方法,观察、比较两组2周内呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率、呛咳例数及护理工时、护士操作依从性等。结果 B组2周内VAP发生率、呛咳例数、护理工时少于A组,护士操作依从性高(P<0.05)。结论与开放式方法对比,采用密闭式冲洗吸引装置行气道冲洗,可有效降低VAP及呛咳发生率,能节约护理工时,提高护士操作依从性。     

益生菌预防新生儿呼吸机相关性肺炎的研究进展

益生菌是一类对宿主有益,互利共生的微生物,在调节人体营养代谢、免疫功能和肠道微生态平衡方面发挥着重要作用。新生儿呼吸机相关性肺炎是新生儿重症监护病房危重患儿应用呼吸机后常见的并发症,常导致住院时间延长、费用增加、抗菌素耐药等后果;也是新生儿死亡的重要原因之一。近年来有大量研究显示,益生菌与新生儿呼吸系统疾病的转归密切相关。本文就益生菌在新生儿呼吸机相关性肺炎临床预防应用中的研究进展进行综述。     

刷牙冲洗口腔护理对呼吸机相关性肺炎的影响

目的:探讨刷牙冲洗口腔护理法对呼吸机相关性肺炎(VAP)的影响。方法:将100例气管插管机械通气患者随机分为两组实验组与对照组各50例。两组均在机械通气开始24 h内进行口腔护理,2次/d,其中对照组进行常规口腔护理,实验组采用刷牙冲洗法进行口腔护理。比较两组患者口腔护理后细菌培养结果及口臭、口腔溃疡、疱疹、发生率。结果:两组患者口腔护理后细菌培养结果比较差异有统计学意义(P<0.05),口臭、口腔溃疡、疱疹、发生率比较差异也有统计学意义(P<0.01)。结论:采用刷牙冲洗法进行口腔护理能够减少患者口腔定植菌,降低口腔感染发生率,从而达到降低VAP发生率的目的。     

首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎发生率的影响

目的探讨首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎(VAP)发生率的影响。方法将入住我院ICU的120例经口气管插管患者随机均分为三组,分别在气管插管后4h内(含4h)、4~8h(含8h)、8~12h(含12h)介入首次口腔护理。比较三组患者早发性呼吸机相关肺炎发生率、机械通气时间、入住ICU时间和病死率等指标。结果三组患者的机械通气时间、入住ICU时间差异有统计学意义,早发性呼吸机相关肺炎发生率、病死率差异无统计学意义。但是,随着首次口腔护理时间的向后推迟,患者的早发性呼肺炎机相关发生率和病死率逐渐升高。结论在插管后4h内介入首次口腔护理,可降低患者的早发性呼吸机相关肺炎发生率与病死率,缩短机械通气时间、入住ICU时间,改善患者预后。