有创呼吸机管路系统不同更换周期与呼吸机相关性肺炎发生的关系

目的探讨有创呼吸机管路系统不同更换周期与呼吸机相关性肺炎（VAP）发生的关系，确定适合的机械通气患者呼吸机管路的更换周期。方法选择96例呼吸衰竭需建立人工气道进行机械通气的患者，采取呼吸机管路及湿化装置，分别间隔3、5、7d更换，分为3d组、5d组、7d组，分别对呼吸机管路的集水杯进行采样和细菌学检测，同时观察3d组患者发生VAP的情况。结果96例患者中共分离出34096株病原菌，革兰氏阳性菌6226株（18％），革兰氏阴性菌27870株（82％），发生VAP70例（24．31％）。3d组2183株（6％），革兰氏阳性菌437株（1％），革兰氏阴性菌1746株（5％），发生VAP7例（7．29％）；5d组7753株（23％），革兰氏阳性菌1383株（4％），革兰氏阴性菌6370株（19％），发生VAP15例（15．63％）；7d组24160株（71％），革兰氏阳性菌4406株（13％），革兰氏阴性菌19754株（58％），发生VAP48例（50．00％）。7d组VAP的发病率明显高于3d组、5d组，差异有统计学意义（P〈0．05），3d组和5d组比较差异无统计学意义。结论呼吸机管路更换时间与VAP发生率相关，建议7d至少更换1次呼吸机管路，可以降低VAP的发生率。

Invasive ventilator piping system replacement cycle with different ventilator associated pneumonia occurred in relation

Objective To study the relationship between different replacement cycle of breathing machine pipeline system and ventilator associated pneumonia （VAP）, also determine the suitable mechanical venti- lation pipe replacement cycle for patients with ventilator. Methods 96 patients with respiratory failure who need artificial airway to achieve mechanical ventilation used breathing machine line spacing and wet- ting device. The replacement intervals were three days, five days, 7 days respectively. And three groups were established, namely, 3-day group, 5-day group, 7-day group and samples were collected respectively from glasses of breathing machine line set. The bacteriology were observed, and VAP in 3-day group were examined at the same time. Results 34 096 strains of pathogenic bacteria from a total 96 of patients were isolated, with 6 226 strains of gram-positive bacteria accounting for 18%, 27 870 strains of gram-negative bacteria accounting for 82% and 70 cases with VAP, accounting for 72.9% ; 3-day group had 2 183 plants （6 %） with 437 strains of gram-positive bacteria accounting for 1%, 1 746 strains of gram-negative bacteria accounting for 5%, 7 cases with VAP accounting for 7.29%; 5-day group had 7 753 strains accounting for 23%, 1 383 strains of gram-positive bacteria accounting for 4%, 6 370 strains of gram-negative bacteria ac- counting for 19% and 15 cases with VAP accounting for 15.63%; among them 7-day group had 24 160 plants accounting for 71%, 4 406 strains of gram-positive bacteria accounting for 13%, 19 754 strains of gram-negative bacteria accounting for 58% and 48 cases with VAP accounting for 50%. The incidence of VAP in 7-day group was obviously higher than that of 3-day and 5-day groups, the difference was statisti- cally significant （P 〈0.05）. There was no significant difference between 3-day group and 5-day group. Conclusion The time of breathing machine pipeline replacement was associated with the incidence of VAP. This study suggests that the breathing machine pipeline should be changed once every 7 days at least, to reduce the incidence of VAP.