建立人工气道机械通气患者气囊放气方法改进

目的观察建立人工气道机械通气患者使用不同气囊放松法对呼吸机相关性肺（VAP）的影响。方法选择89例建立人工气道机械通气48h以上的患者,按随机原则分为传统组和改进组,定期收集下呼吸道深部分泌物进行培养,记录发生VAP的例数、时间及病原体。结果改进组的VAP发生率（31%）低于传统组（54%）（P〈0.05）,改进后的气囊放松法可降低革兰氏阳性球菌及流感嗜血杆菌所引起的VAP的发病,而对铜绿假单胞菌、不动杆菌、各种肠杆菌及白色念珠菌引起的VAP发生率无明显影响。改进组的VAP发生时间（14±8）d迟于传统组（6±4）d（P〈0.05）。结论改进后的气囊放松法简单易行,可延迟VAP的发生,降低VAP的发生率,特别是革兰氏阳性球菌及流感嗜血杆菌所致的VAP的发生率。

Improvement of aerocyst-slacken in mechanical-ventilation patient

Objective To describe the effects of two kinds of aerocyst-slacken in mechanical-ventilation patient.Methods 89 patients with mechanical ventilation longer than 48 hours were randomly divided into two groups：Improvement groups and traditional groups.The secretion from deep respiratory tract were cultivanted.The observation was made on the occurrence time and incidence of ventilator-associated pneumonia（VAP） and pathogenic bacteria.Results The incidence of ventilator-associated pneumonia（VAP） in Improvement groups（31%） was lower than traditional groups（54%）（P0.05） and the occurrence time of ventilator-associated pneumonia（VAP） in Improvement groups（14±8）d was latter than raditional groups（6±4）d（P0.05）.The improvement of aerocyst-slacken reduced the incidence of VAP by G＋ coccobacteria and hemophilies influenzae,but had no influence in the incidence of VAP by pseudomonas aeruginosa,BACT,enteric bacilli and blastomyces albicans.Conclusion The improvement of aerocyst-slacken is easy to perform,delay the occurrence time of VAP,reducehe incidence of VAP by G＋ coccobacteria and hemophilies influenzae.