两种气管导管预防机械通气患者呼吸机相关性肺炎效果比较

目的探讨圆柱形与锥形气囊气管导管对机械通气患者微误吸致呼吸机相关性肺炎(VAP)的预防效果。方法将机械通气≥48h的气管插管患者64例随机分为A组32例,采用圆柱形气囊气管导管;B组32例,采用锥形气囊气管导管。将机械通气≥48h的气管切开患者72例随机分为C组36例,采用圆柱形气囊气管导管;D组36例,采用锥形气囊气管导管。观察并记录四组患者VAP发生率和时间、机械通气时间、痰液变化量、声门下分泌物变化量、脱机成功率。结果 B、D组VAP发生率显著低于A、C组;痰液变化量和声门下分泌物变化量显著多于A、C组(P0.05,P0.01)。四组机械通气时间、7d内脱机成功率、14d内脱机成功率差异无统计学意义(均P0.05)。结论使用锥形气囊的气管导管可以更好地预防微误吸的发生,从而预防VAP的发生。

Effect comparision on prevention of ventilator associated pneumonia using two kinds of tracheal tube for patients undergoing mechanical ventilation

Objective To explore the preventive effect of misinhalation induced ventilator associated pneumonia (VAP) using a cylindrical or conical gasbag tracheal tube for patients undergoing mechanical ventilation.Methods A total of 64 patients with tracheal intubation and undergoing mechanical ventilation ≥48 h were randomized into a group A and a group B,with 32 patients in each group.Another 72 patients with tracheostomy and undergoing mechanical ventilation ≥48 h were randomized into a group C and a group D,with 36 patients in each group.Group A and C used cylindrical gasbag tracheal tubes,while group B and D utilized conical gasbag tracheal tubes.The incidence and onset of VAP,duration of mechanical ventilation,sputum variation,subglottic secretion variation and the success rate of ventilator weaning were observed and recorded among the 4 groups.Results The incidence of VAP in group B and group D was significantly lower than that in group A and group C,and sputum variation and subglottic secretion variation were significantly more than those in group A and group C (P＜0.05,P＜0.01).While there were no significant differences in duration of mechanical ventilation,the success rates of ventilator weaning within 7 and 14 days among the 4 groups (P＞0.05 for all).Conclusion Utilization of tracheal tube with a conical gasbag can effectively prevent misinhalation,then prevent VAP.