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。

Comparison of the effects of closed versus open suction systems on the development of ventilator-associated pneumonia in neonates

Objective To compare the effects of closed and open suction systems（CSS and OSS） on the development of ventilator-associated pneumonia（VAP） in neonates.Methods A total of 52 intubated and ventilated neonates in the intensive unit（ICU） in our hospital from September 2009 to May 2010 were randomized to receive endotracheal suction with either closed catheters（CSS group;n=22） or single-use catheters（OSS group;n=30）.Cultures were taken from the ventilator tubing of 52 neonates to determine the rate of colonization.Results There were no differences between the two groups in VAP incidence and mortality.All the colonization isolates were extensively drug-resistant Gram-negative bacilli in the two groups.There were more species of bacteria in OSS group,but not significantly different from CSS group.Conclusion There is no difference in the development of neonatal VAP between CSS and OSS.But CSS can obviate the physiological disadvantages of ventilator disconnection with no increase in the rate of bacterial airway colonization.The standardized procedures and catheter nursing are very important for the prevention of neonatal VAP.