密闭式吸痰装置更换频率对呼吸机相关性肺炎影响的Meta分析

目的 系统评价密闭式吸痰装置更换频率对呼吸机相关性肺炎的影响。方法 计算机检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、万方数据库中有关密闭式吸痰装置更换频率的随机对照试验,由2名研究者独立对获得文献进行筛查、质量评价和资料提取,采用Revman 5.3软件进行Meta分析。结果 最终纳入7篇随机对照试验,共1098例患者,Meta分析结果显示,每48h及以上与每24h更换密闭式吸痰装置相比,呼吸机相关性肺炎发生率的差异无统计学意义（P>0.05）;亚组分析显示,每48h、每72h或每120h更换密闭式吸痰装置对呼吸机相关性肺炎发生率的影响,差异无统计学意义（P>0.05）;每72h及以上更换的密闭式吸痰装置尖端菌群定植率高于每24h更换组（P<0.05）;密闭式吸痰装置更换频率对于患者的机械通气时间、ICU住院日、病死率均无影响（P>0.05）。结论 密闭式吸痰装置的更换频率对呼吸机相关性肺炎的发生率无影响,但超过72h更换,密闭吸痰装置尖端细菌定植率显著增加,建议临床每72h更换密闭式吸痰装置以减少尖端细菌定植,预防进一步感染。     

密闭式吸痰预防呼吸机相关性肺炎的观察效果

[目的]观察密闭式吸痰在预防呼吸机相关性肺炎（VAP）中的作用及密闭式吸痰管使用时间对VAP发生的影响。[方法]将收入ICU的有创机械通气经口气管插管和机械通气超过48h的病人入选，共80例，其中67例完成。应用随机数字表法将其分为3组，接受开放式吸痰的为A组，接受密闭式吸痰吸痰管24h更换为B组，接受密闭式吸痰吸痰管48h更换为C组，比较发生VAP的时间及发生率。[结果]A组与B组、A组与C组VAP发生率比较，有统计学意义（P〈0．05）；接受密闭式吸痰24h与48h更换吸痰管VAP发生率比较，无统计学意义（P〉0．05）。[结论]在ICU机械通气的病人中，采用密闭式吸痰管是有效地预防VAP的措施之一，且密闭式吸痰管更换时间可达48h，较24h更换者降低了住院费用。     

密闭式吸痰预防呼吸机相关性肺炎的观察效果

[目的]观察密闭式吸痰在预防呼吸机相关性肺炎(VAP)中的作用及密闭式吸痰管使用时间对VAP发生的影响。[方法]将收入ICU的有创机械通气经口气管插管和机械通气超过48h的病人入选,共80例,其中67例完成。应用随机数字表法将其分为3组,接受开放式吸痰的为A组,接受密闭式吸痰吸痰管24h更换为B组,接受密闭式吸痰吸痰管48h更换为C组,比较发生VAP的时间及发生率。[结果]A组与B组、A组与C组VAP发生率比较,有统计学意义(P<0.05);接受密闭式吸痰24h与48h更换吸痰管VAP发生率比较,无统计学意义(P>0.05)。[结论]在ICU机械通气的病人中,采用密闭式吸痰管是有效地预防VAP的措施之一,且密闭式吸痰管更换时间可达48h,较24h更换者降低了住院费用。     

不同吸痰管在心外科ICU术后机械通气患者中应用的效果比较

目的比较应用密闭式吸痰管和开放式吸痰管对成人心外科术后感染预防和控制效果的影响。方法选择心外科术后行机械通气患者159例,随机分为密闭式吸痰组（n=77）和开放式吸痰组（n=82）,比较两组患者术后当天及术后第1,2,3天的白细胞计数,拔管前痰培养阳性率及总机械通气时间。结果密闭式吸痰组与开放式吸痰组的白细胞计数在术后当天[（10．42±3．81）×10^9／L比（9．44±3．36）×10^9／L]和第1天[（12．03±3．87）×10^9／L比（11．32±3．59）×10^9／L]差异无统计学意义（t分别为-1．718,-1．188;P〉0．05）;而密闭式吸痰组白细胞计数术后第2天[（16．14±5．78）×10^9／L比（14．81±3．68）×10^9／L]、第3天[（15．09±5．91）×10^9／L比（12．65±3．18）×10^9／L]高于开放式吸痰组,差异有统计学意义（t分别为-2．044,-2．409;P〈0．05）。密闭式吸痰组痰标本细菌培养阳性率高于开放式吸痰组（12．2％比10．4％）,但差异无统计学意义（χ2=0．129,P=0．72）,总机械通气时间长于开放式吸痰组[（14．48±4．71）h比（12．15±4．47）h],差异有统计学意义（t=2．994,P=0．003）。结论密闭式吸痰管的吸痰效果不及开放式吸痰管,由于吸痰不彻底导致的细菌定植发生率较高,从而导致肺部感染率增加。而且对于心外科术后短期带管的患者来说,密闭式吸痰装置的费用较高。     

密闭式吸痰管更换频率对VAP发生及疾病预后的影响

既往的开放式吸痰需中断呼吸机治疗及交叉污染等缺点,而密闭式吸痰无这一弊端,因此密闭式吸痰管（CSC）的应用越来越广泛。但更换频率一直存有争议,频繁更换费用高,易感染,CSC在吸痰过程中需接触痰液,长时间使用也存在细菌定植的可能,而聚集在吸痰管表面的定植菌群可能有导致或增加呼吸机相关性肺炎（VAP）的风险,所以优化CSC更换频率就显得非常重要。     

密闭式吸痰器与一次性吸痰管吸痰效果的比较

目的比较密闭式吸痰器与一次性吸痰管的吸痰效果。方法采用方便取样法,选择北京市某三级甲等医院心脏外科ICU行心脏外科手术的术后患者100例,随机分为实验组和对照组各50例。实验组使用密闭式吸痰器,对照组使用一次性吸痰管,由护士随机对两组患者进行吸痰操作,从术后机械通气时间、术后机械通气期间的平均每次吸痰时间、平均吸痰间隔时间、氧分压和脉氧饱和度均值、经人工气道吸痰费用进行分析对比。结果两组患者术后机械通气时间差异无统计学意义（P〉0．05）;实验组平均每次吸痰时间、平均吸痰间隔时间均少于对照组,差异有统计学意义（P〈0．05）;实验组氧分压和脉氧饱和度均值、经人工气道吸痰费用均高于对照组,差异有统计学意义（P〈0．01）。结论密闭式吸痰器的临床吸痰效果优于一次性吸痰管,增加了患者术后机械通气期间的氧储备,提高了护士吸痰操作的主动性,减轻了护理工作量,但费用较高。     

吸痰过程中冲管液更换时间选择探讨

目的:确定吸痰过程中冲管液的更换时间。方法:将100例需吸痰患者随机分成两组,1组采用吸痰过程中冲管液4 h更换,2组采用吸痰过程中冲管液12 h更换,观察两组冲管液的细菌阳性率。结果:1组冲管液细菌阳性率明显低于2组。结论:吸痰过程中冲管液4 h更换一次是合理的。     

呼吸衰竭患者不同吸痰方式吸痰效果的比较

目的探讨不同吸痰方式对呼吸衰竭机械通气患者吸痰前后呼吸循环参数的影响。方法将40例呼吸衰竭使用呼吸机的患者随机分为对照组和观察组,各20例。观察组采用密闭式吸痰,对照组采用传统的开放式吸痰,采取受试者自身前后对照的方法,观察患者吸痰前后呼吸循环参数的变化。结果密闭式吸痰前后患者呼吸循环参数差异无统计学意义（P〉0．05）,开放式吸痰前后心率、SpO2、Ppeak、Pplat参数差异有统计学意义（P〈0.01）,收缩压、RR、PaO2参数差异有统计学意义（P〈0.05）,Vt、PaCO2参数差异无统计学意义（P〉0.05）。结论呼吸衰竭患者使用密闭式吸痰方法较开放式吸痰方法安全有效。     

气管内开放式与密闭式吸痰效果比较

目的 比较密闭式吸痰与开放式吸痰的临床效果。方法 实验组36例气管插管及气管切开的患者应用密闭式吸痰管吸痰,对照组38例用开放式吸痰管吸痰,两组患者年龄、病情、气管插管及气管切开时间经统计学分析P＞0．05具有可比性,两种吸痰方法从肺部感染发生时间、感染率、痰阻、工作量四方面比较。结果 实验组肺部感染发生时间延迟（一周后）,感染率降低,与对照组间差异有显著性意义（P＜0．05）,痰阻发生率两组间差异也有显著性意义（P＜0．05）,工作量实验组（平均16s/次）明显少于对照组（平均28s/次）。结论 密闭式吸痰效果优于开放式吸痰,能降低肺部感染,防止痰阻、减轻护理工作量。     

吸痰管刺激咳嗽法在婴儿经口吸痰中的应用

目的比较两种不同经口吸痰方法在婴儿吸痰中的应用效果。方法将经121吸痰的76例婴儿及家属按随机数字表法分为观察组和对照组各38例，观察组采用吸痰管刺激咳嗽法吸痰，对照组采用直接吸痰法吸痰。比较两种方法的吸痰效果、吸痰总次数以及家属满意度。结果观察组的吸痰有效率（94．7％）、吸痰总次数（8次）以及家属满意度（97．6％）与对照组（73．7％，21次，82．6％）比较，差异均有统计学意义（x2分别为6．33，5．17，4．29；P〈0．05）。结论采用吸痰管刺激咳嗽法吸痰更能减轻婴儿的痛苦，增加家属满意度，减少临床护理工作量。     

引流袋更换频率对引流尿液细菌污染的影响

目的探讨引流袋更换频率对引流尿液细菌污染的影响。方法选择2007年2月至2008年11月我院重症监护室、神经内科、神经外科卧床留置导尿患者180例,随机分为3组,所有患者均使用密闭式引流袋。A组每天更换1次引流袋,共72例;B组每3d更换1次引流袋,共52例;C组每7d更换1次引流袋,共56例。分别于留置导尿后次日起按无菌操作技术隔天1次取尿液送尿细菌培养,连续留检5次。结果三组患者的尿培养致病菌阳性结果比较,差别有统计学意义（P〈0．01）;A、B组尿培养致病菌阳性结果比较,差别有高度统计学意义（P〈0．01）;B、C组尿培养致病菌阳性结果比较,差别有统计学意义（P〈0．01）;A、C组尿培养致病菌阳性结果比较,差别无统计学意义（P〉0．05）。结论引流袋更换频率影响引流尿液的细菌污染状况,应以每3d更换1次为宜。     

两种吸痰法对新生儿发生呼吸机相关性肺炎的影响

目的探讨密闭式吸痰（CSS）法与开放式吸痰（OSS）法对新生儿发生呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的影响。方法选择2009年9月—2010年5月在我院重症监护病房（ICU）行气管插管患儿52例,采用便利取样随机分为CSS组22例和OSS组30例,记录两组患儿的基本资料、VAP发生例数和呼吸道医院感染的菌群情况。结果两组患儿VAP发生率、病死率比较差异无统计学意义,两组患儿呼吸道内培养出的菌株全部为泛耐药的革兰阴性杆菌;OSS组的菌株种类杂、数量多。结论对新生儿来说,采用不同的吸痰方法不是VAP发生的主要因素,也没有增加泛耐药菌的定植。但无论采用哪种吸痰方式,规范的操作和导管护理都是重要的措施,是防止新生儿VAP发生的重要步骤。     

早期持续壁负压吸引对乳腺癌术后皮下积液预防作用的临床评价

目的 通过对乳腺癌改良根治术后患者的临床病例资料统计对比分析,探讨术毕即刻持续壁负压吸引对乳腺癌患者术后皮下积液发生率的影响.方法 回顾性分析2011年6月至2012年9月改良根治术治疗的120例乳腺癌患者临床病例资料,将其随机分为三组：试验A组40例患者双管引流,术毕即刻外接壁负压持续吸引,24h后改为每2 h一次（q2 h）间断壁负压吸引;试验B组40例患者双管引流,术毕24h后外接壁负压q2h间断吸引;对照C组40例患者双管引流,术毕外接普通负压鼓引流,比较三组对术后皮下积液发生的影响.结果 三种不同术后引流方式对皮下积液发生率（x2=12.834,P＜0.05）、置管天数（x2=14.064,P＜0.05）及皮下积液累及范围（x2=12.468,P＜0.05）的影响均具有统计学差异.术毕即刻持续壁负压吸引组（A组）与对照组（C组）比较,积液发生率降低（x2=12.624,P＜0.05）,置管天数缩短（x2=11.665,P＜0.05）,积液累及范围减小（x2=11.25,P＜0.05）;与间断壁负压吸引组（B组）比较,积液发生率降低（x2 =4.114,P＜0.05）,置管天数（x2=1.127,P＞0.05）及积液累及范围（x2=2.222,P＞0.05）统计学差异不明显.结论 术毕即刻持续壁负压吸引较间断壁负压吸引及传统吸引方式更好的预防皮下积液的发生,临床统计数据具有统计学意义.     

Activity of antibacterial impregnated central venous catheters against Klebsiella pneumoniae

OBJECTIVE: Antibiotically coated or impregnated catheters are effective in eliminating gram-positive bacteria from their surfaces. However, their activity against gram-negative bacteria is not well known. The aim of this study was to evaluate and compare the adherence, persistence and colonization of Klebsiella pneumoniae on catheter surfaces and also to assess bacteriostatic and bactericidal levels. DESIGN: Randomized, controlled, laboratory study. SETTING: University surgical microbiology laboratory. SUBJECTIVE: Silver sulfadiazine-chlorhexidine impregnated (SSC), minocycline and rifampin bonded (M+R), silver, platinum and carbon incorporated (SP+C) and non-antiseptic central venous catheter segments. INTERVENTIONS: Catheter segments were immersed in 1 ml of phosphate buffered saline (0.01 mol/l) with 0.25% dextrose (PBSD) and incubated at 37 degrees C. The PBSD was replaced daily. Effluents were frozen at -70 degrees C for subsequent determination of bacteriostatic and bactericidal activity. On days 1,3,7,14 and 21 after initial immersion, 1 ml standardized inoculum of Klebsiella pneumoniae was added to 90 tubes for a period of 30 min. The inoculum was then replaced with PBSD. One third of the samples were immediately sonicated and plated for the determination of bacterial adherence. The remaining segments were incubated for 4 and 24 h, followed by the same procedure to determine bacterial persistence and colonization with time. All plates were read after 24 h of incubation. MEASUREMENTS AND RESULTS: There was a significant reduction in initial bacterial adherence for SP+C catheters on all days ( p<0.05). SSC catheters prevented initial bacterial adherence for the first 7 days only ( p<0.05). SSC and SP+C catheters prevented bacterial persistence and further colonization on all days. However M+R catheters prevented bacterial colonization for 3 days only. Effluent studies indicated that the impregnated agents in catheter SSC were bactericidal compared to catheter M+R, which were bacteriostatic to K. pneumoniae. No antibacterial activity was detected in the effluents from catheter SP+C. CONCLUSIONS: SSC and SP+C catheters are effective in eliminating K. pneumoniae from their surfaces for at least 21 days. M+R catheters are less effective in eliminating bacterial adherence and colonization may be due to their bacteriostatic property.     

Antimicrobial-coated endotracheal tubes: an experimental study

OBJECTIVE: Antibiotic-resistant bacterial biofilm may quickly form on endotracheal tubes (ETTs) and can enter the lungs, potentially causing pneumonia. In an attempt to prevent bacterial colonization, we developed and tested in an in-vitro study and animal study several antibacterial-coated ETTs (silver sulfadiazine with and without carbon in polyurethane, silver sulfadiazine and chlorhexidine with and without carbon in polyurethane, silver-platinum with and without carbon in polyurethane, chlorhexidine in polyurethane, and rose bengal for UV light). DESIGN, SETTING, ANIMALS, INTERVENTIONS: After preliminary studies, silver sulfadiazine in polyurethane (SSD-ETT) was selected among the coatings to be challenged every 24 h with 10(4)-10(6) Pseudomonas aeruginosa/ml and evaluated at 6 h, 24 h, and 72 h with standard microbiological studies, scanning electron microscopy, and confocal scanning microscopy. Subsequently, eight sheep were randomized to receive either a SSD-ETT or a standard ETT (St-ETT). After 24 h of mechanical ventilation, standard microbiological studies were performed together with scanning electron microscopy and confocal microscopy. MEASUREMENTS AND RESULTS: In the in-vitro study SSD-ETT remained bacteria-free for up to 72 h, whereas St-ETT showed heavy P. aeruginosa growth and biofilm formation (p < 0.01). In sheep, the SSD-ETT group showed no bacterial growth in the ETT, ventilator tubing, and lower respiratory tract, while heavy colonization was found in the St-ETT (p < 0.01), ventilator tubing (p=0.03), and lower respiratory tract (p < 0.01). CONCLUSION: This study describes several effective and durable antibacterial coatings for ETTs. Particularly, SSD-ETT showed prevention against P. aeruginosa biofilm formation in a 72-h in-vitro study and lower respiratory tract colonization in sheep mechanically ventilated for 24 h.     

Efficacy of silver-coating central venous catheters in reducing bacterial colonization

OBJECTIVE: To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. DESIGN: Prospective, randomized clinical trial. SETTING: Intensive care unit in a university hospital. PATIENTS: Patients after cardiac surgery who required a central venous double-lumen catheter (DLC). INTERVENTIONS: Sixty-seven adult patients were prospectively randomized to receive either a silver-coated (S group, n = 34) or an uncoated control (C group, n = 33) DLC. Blood cultures were drawn at catheter removal, and removed catheters were analyzed with quantitative cultures. Typing of microorganisms included DNA fingerprinting. MEASUREMENTS AND MAIN RESULTS: Catheters were removed if no longer necessary and aseptically divided into three segments: segment A, the catheter tip; segment B, an intermediate section; and segment C, the subcutaneous portion. Bacterial catheter colonization was quantitatively measured using sonication to detach adherent bacteria from the catheter segments in the broth and subsequent culture of an aliquot. Selected isolates of coagulase-negative staphylococci and other bacteria from catheter segments were examined by means of pulsed-field gel electrophoresis (PFGE) after macrorestriction digestion of bacterial DNA to study colonization pathogenesis. Quantitatively lower bacterial colonization could be demonstrated on the silver-coated catheters (200 +/- 550 colony forming units [CFUs]/cm catheter segment; mean +/- SD). The difference in the control catheters (1120 +/- 5350 CFUs/cm catheter segment; mean +/- SD) was not, however, significant (p = .25). The frequency of colonization of at least one catheter segment was 52.9% for the silver-coated catheters and 57.6% for the control catheters (p= .44), without any significant differences in the colonization of corresponding catheter segments. The rate of significant catheter colonization (i.e., > or = 10(3) CFUs/cm catheter by quantitative catheter culture or > or = 10(3) CFUs/mL by luminal flush) was nine in the silver group and seven in the control group, a difference that failed to reach significance (p = .41). Two patients in both groups developed catheter-related bacteremia. Pattern analysis after PFGE demonstrated that about 70% of the isolates found on the catheter tip were identical with those on the skin at the insertion site, whereas about 75% were identical with those recovered from the hub. In 29% of colonized catheters, identical bacteria were found on the hub and the skin at the insertion site. CONCLUSIONS: Silver-coating of DLCs did not significantly reduce bacterial catheter colonization compared with the control catheters. PFGE analysis of coagulase-negative staphylococci and other bacteria demonstrated various pathogenic routes of catheter-related colonization, whereby the microorganisms of the skin flora around the insertion site must be regarded as the main source of catheter-related infections.     

中心静脉导管尖端细菌定植危险因素的病例对照研究

目的 探讨中心静脉导管尖端细菌定植的危险因素.方法 抽取一段时间内某院住院并接受中心静脉置管的患者240例,以导管尖端细菌培养阳性者作为病例组,阴性者作为对照组.对可能影响细菌定植的因素作单因素分析与Logistic多元回归分析.结果 排除可疑污染的阳性病例5例,30例导管尖端有细菌定植,单因素分析共筛选出插入导管型号、拔管前是否有发热、拔管时穿刺点皮肤、导管使用过程中抗生素的使用情况、从导管有无输血、从肝素帽推药次数6方面因素有统计学意义(P<0.05);以有细菌定植为应变量,其他因素为自变量赋值后进行非条件多因素分析,最终显示导管型号、抗生素的使用2方面因素是导管尖端细菌定植的危险因素.结论 选择合适的导管,做好穿刺点护理,严格控制置管天数,合理使用抗生素,有效预防导管相关性血流感染的发生.     

微创置管胸腔引流与常规胸腔穿刺治疗恶性胸腔积液的效果观察

目的观察微创置管胸腔闭式引流与常规胸腔穿刺后注药治疗恶性胸腔积液的临床疗效。方法将58例恶性胸腔积液患者随机分成A（n=30）、B（n=28）2组,分别进行微创置管闭式引流和常规胸腔穿刺,并均于胸腔内注入化疗药物。结果A组胸腔积液控制的总有效率为83．3％,明显优于B组的57．1％（P〈0．05）。结论应用微创置管引流恶性胸腔积液操作安全、简便,能最大限度地排净胸腔积液,对控制癌性胸腔积液有较好的疗效,能显著改善患者生活质量。     

单次高负荷剂量辛伐他汀对心房颤动患者高敏C反应蛋白及转复成功率的影响

[目的]探讨单次高负荷剂量辛伐他汀对阵发性心房颤动患者转复成功率的影响.方法：68例急性冠脉综合征合并阵发性心房颤动患者随机分为观察组（n=33）和对照组（n=35）.对照组给予胺碘酮进行药物复律,并同时口服常规剂量辛伐他汀和稳心颗粒,观察组在对照组基础上加服单次负荷剂量辛伐他汀（80 mg）.观察两组患者房颤复率成功率,并检测用药前和用药后24 h、72 h和7 d高敏C反应蛋白（hs-CRP）水平.[结果]观察组在各时间点上复律成功率均显著高于对照组,且在用药后24 h即出现hs-CRP显著下降,在各时间点上均低于对照组.[结论]胺碘酮复律前给予高负荷剂量辛伐他汀能降低阵发性心房颤动患者hs-CRP水平,提高转复成功率.     

Antibacterial activity of linezolid and vancomycin in an in vitro pharmacodynamic model of gram-positive catheter-related bacteraemia

OBJECTIVES: The aim of this study was to compare the activity of linezolid and vancomycin in an in vitro pharmacodynamic model to assess potential differences in activity against biofilm-embedded organisms. METHODS: Single-lumen central venous catheters colonized with biofilm-embedded Staphylococcus aureus, Staphylococcus epidermidis or vancomycin-resistant Enterococcus faecium (VRE) were treated with simulated clinical dosing regimens of linezolid 600 mg every 12 h or vancomycin 1 g every 12 h in a one-compartment in vitro pharmacodynamic model. Quantitative cultures were sampled through the catheter and peripheral ports over 48 h to dynamically assess changes in the burden of catheter colonization and organism seeding, respectively. At 24 and 48 h catheters were removed, sonicated and cultured for adherent organisms. RESULTS: Both linezolid and vancomycin suppressed bacterial growth on the catheter and release of S. aureus and S. epidermidis into the model compared with controls (P < 0.05), while linezolid also suppressed counts compared with control and vancomycin versus VRE. Neither agent completely eradicated bacterial colonization of the catheters. MICs for the isolates recovered from the model did not increase over time with linezolid or vancomycin exposure. CONCLUSIONS: Lack of activity against biofilm-embedded organisms appeared to be the primary reason for microbiological failure of both drugs in the model.