振动排痰预防重型颅脑损伤患者呼吸机相关性肺炎的效果

目的探讨振动排痰预防重型颅脑损伤(severe brain injury,SBI)患者呼吸机相关性肺炎(ventilator assoeiated pneumonia,VAP)发生的效果。方法便利选取2011年6月至2014年5月解放军第102医院收治的155例SBI患者为研究对象,采用随机数字表法分为两组,对照组采用传统叩背排痰法,研究组采用振动排痰法。对两组患者进行前瞻性随访研究,随访的起点事件是应用呼吸机,终点事件为出现VAP,截止时间是拔管后48h或死亡。无VAP生存率估算应用Kaplan-Meier法,组间生存曲线差异采用log-rank检验。结果研究组有12例患者发生VAP,发生中位时间为9.25(4.5~16)d;对照组有21例患者发生VAP,发生中位时间为7.5(2~13)d。两组之间无VAP生存曲线差异有统计学意义(χ2=4.712,P=0.030)。结论振动排痰能够预防SBI患者发生VAP,有助于改善SBI患者的预后,提高护理效果。

Effect of Vibration on Prevention of Ventilator-associated Pneumonia in Patients with Severe Brain Inj ury

Objective To explore the impact of vibration expectoration on prevention of ventilator-associated pneumonia（VAP）in patients with severe brain inj ury（SBI）.Methods By convenience sampling, 1 5 5 SBI patients were selected and randomly divided into control group and study group.The control group were given traditional expectoration method and the study group were given vibration expectoration method.Two groups were followed up,the start point of follow up was the application of ventilator,the end point was the incidence of VAP,and the end time was the 48 h after extubation or death.Kaplan-Meier method was used to estimate non-VAP survival rate.The survival difference between the two groups was compared using the log-rank test.Results 12 cases of the study group occurred VAP,with a median of 9.25 days （range 4.5-16 days）;21 cases of the control group occurred VAP,with a median of 7.5 days （range 2-13 days）.Non-VAP survival curves showed significant differences between the two groups （χ2= 4.712, P=0.030）.Conclusion Vibration expectoration can prevent VAP in patients with SBI,which helps to im-prove the prognosis of SBI patients and care effect.