气管插管的时机以及创伤后机械通气相关性肺炎

目的探讨气管插管的时机以及创伤后机械通气相关性肺炎(VAP)的临床研究。方法回顾2009年1月~2011年10月经院前(PH)或呼吸科内(RD)气管插管处理后的成年创伤患者。VAP的诊断采用支气管镜下肺泡灌洗的方法,不能肺泡灌洗的用临床评估的方法。次级结果包括VAP发生时间、住院时间和住院死亡率。结果 286例患者中,206例(72.0%)行PH插管(PH组),80例(28.0%)行RD插管(RD组)。RD组年龄高于PH组(平均年龄分别为46.4岁和39.1岁,P<0.01)。两组最低收缩压的平均值比较,RD组低于PH组(分别为102.8 mm Hg和111.4 mm Hg,P<0.01)(1 mm Hg=0.133 kPa),两组创伤严重度评分差异无统计学意义(分别为27.2分和27.0分,P=0.94)。两组间VAP发生率差异无统计学意义[分别为30(18.8%)和71(17.2%),P=0.66],诊断时间差异无统计学意义(分别为8.1 d和7.8 d,P=0.89)。经Logistic回归分析确定药物滥用史、急诊室内测得的最低收缩压、创伤严重程度评分为发生VAP的三个独立因素。结论创伤患者院前气管插管的VAP发生率并不高于呼吸科内气管插管。关于气管插管时机、吸痰时机等因素还需进一步研究,以避免VAP的发生。

The timing of tracheal intubation and ventilator-associated pneumonia after trauma

Objective To investigate the timing of tracheal intubation and ventilator-associated pneumonia（VAP） after trauma.Methods From January 2009 to October 2011,the clinical data of adult trauma patients with tracheal intubation pre-hospital（PH） or respiratory department（RD） were retrospectively analyzed.The diagnosis of VAP were used bronchoscopic lavage,the patients cannot be used bronchoscopic lavage with clinical assessment method.Secondary outcomes included the incidence of VAP,length of stay and hospital mortality.Results In 286 patients,206 cases（72.0%） underwent pre-hospital intubation（PH group）,80 cases（28.0%） underwent respiratory department intubation（RD group）.The age of RD group was higher than the PH group（the mean age were 46.4 years and 39.1 years,P 0.01）.The lowest average systolic blood pressure of two groups were compared,RD group was lower than the PH group（respectively for 102.8 mm Hg and 111.4 mm Hg,P 0.01）（1 mm Hg=0.133 kPa）,despite of the average injury severity score of two groups were similar（respectively for 27.2 scores and 27.0 scores,P = 0.94）.There was no difference in the incidence of VAP of two groups [respectively for 30（18.8%） and 71（17.2%）,P = 0.66],and no difference in the diagnosis time [respectively for 8.1 days and 7.8 days,P = 0.89）.Logistic regression analysis identified that the history of drug abuse,the lowest measured systolic blood pressure in emergency room and injury severity score were the independent factors for the occurrence of VAP.Conclusion The incidence of VAP of trauma patients with pre-hospital endotracheal intubation is not above tracheal intubation in respiratory department.The timing of tracheal intubation,sputum aspiration and other factors need to be intensively studied,in order to avoid the incidence of VAP.