持续声门下吸引预防机械通气患者发生呼吸机相关性肺炎

目的:评价持续声门下吸引(CASS)对预防机械通气患者发生呼吸机相关性肺炎(VAP)的临床价值。方法:将2010年6月1日-2012年6月1日我院重症监护病房(ICU)需建立人工气道实施机械通气(MV)的18岁以上患者作为观察对象,排除入ICU前已建立人工气道或MV时间不足48h患者。入选患者随机分为CASS组(A组)和不行声门下吸引组(B组)。记录患者一般资料,VAP发生时间及例数,CASS组声门下7d内引流量,以及两组患者预后。结果:共96例患者入选,A组51例,B组45例。A组患者VAP发生率明显低于B组(P=0.010),两组患者MV 7d内VAP发生率具有更显著的差异(P=0.007),MV 7d后VAP发生率无显著差异(P=0.856)。A组患者VAP发生时间较B组延迟(P=0.000)。两组患者病死率无显著差异(P=0.777)。CASS组内VAP患者病死率明显高于未发生VAP者(P=0.040),发生VAP患者声门下7d内平均引流量明显少于未发生VAP者(P=0.000)。结论:有效的CASS可降低MV患者VAP发生率,尤其是早发VAP发生率。CASS可使MV患者VAP发生时间延迟,对MV患者病死率无显著改善。

Effect of Continuous Aspiration of Subglottic Secretion on the Prevention of Ventilator-associated Pneumonia in Mechanically Ventilated Patients

Objective:To evaluate the clinical effect of continuous aspiration of subglottic secretion(CASS) on the prevention of ventilator-associated pneumonia(VAP) in mechanically ventilated(MV) patients.Methods:Patients mechanically ventilated,aged more than 18 years old,at the ICU from June 1st,2010 to June 1st,2012 in our hospital were randomly divided into 2 groups,either received continuous aspiration of subglottic secretion(Group A) or routine postoperative medical care without CASS(Group B),excluding applied artificial airway or time of mechanically ventilated less than 48 hours.The general information of patients,number of VAP patients,the specific time of occurrence of VAP,daily volume of subglottic secretions and prognosis of the 2 groups were recorded.Results:96 patients were included in the study,51 cases in the group A,compared with 45 cases in the group B.The incidence of VAP in the group A was much lower than that in the group B(P=0.010).In the first 7 days there was significant difference in the onset of VAP between the two groups(P=0.007),relatively,no difference after 7 days(P=0.856).The onset of VAP was delayed in group A as compared with group B(P=0.000).No statistically significant differences for hospital mortality were found between the two treatment groups.The mortality with VAP was much higher than that with no-VAP in the group A(P=0.04),and the average volume of subglottic secretions in patients with VAP was lower than that with no-VAP in the 7 days(P=0.000).Conclusion:Efficacious CASS reduced the occurrence and delayed the onset of VAP among patients with MV,but did not obviously lowered the mortality.