集束化干预在机械通气预防呼吸机相关性肺炎中的应用

目的：探讨机械通气患者实施集束化干预在预防呼吸机相关性肺炎（VAP）中的应用。方法选取2011年4月至2012年6月进行机械通气大于或等于48 h 的患者110例。随机分为口腔冲洗组36例（对照组）、口腔冲洗结合气囊上滞留物引流组37例（气囊上滞留物引流组）和口腔冲洗、气囊上滞留物引流联合半坐位组37例（集束化组），观察3组患者 VAP 发生率、VAP 病死率、机械通气时间和住 ICU 时间。结果气囊上滞留物引流组和对照组在机械通气第3、7天 VAP 发生率比较差异有统计学意义（P ＜0．05）；集束化组与对照组在 VAP 发生率方面比较差异有统计学意义（P ＜0．05），在大于9 d 与气囊上滞留物引流组比较差异有统计学意义（P ＜0．05），机械通气时间和住 ICU 时间明显缩短。一旦发生 VAP，3组患者的病死率比较差异无统计学意义（P ＞0．05）。结论机械通气患者严格执行半坐卧位，加强口咽部各环节的干预管理，对预防呼吸机相关性肺炎有重要意义。

Effect of cluster intervention on ventilator-associated pneumonia with mechanical ventilation

Objective To investigate the effect of cluster interventions for prevention of ventilator-associated pneumonia (VAP)on mechanical ventilation.Methods A total of 110 patients with mechanical ventilation more than 48 hours at the intensive care unit(ICU)between April 2011 and June 2012 were randomly divided into three groups:control group(n=36),subglottic secre-tion drainage(SSD)group(n=37),cluster(CL)group(n=37).At the end of study,VAP incidence rate,VAP related death rate, duration of mechanical ventilation,ICU length of stay(LOS)were investigated and compared among the three groups.Results The morbidities of VAP between control group and SSD group were significantly different in the third day,the 7th day of mechanical ventilation.The morbidity of VAP of CL group was lower than that of control group,The morbidity of VAP of CL group was lower than that SSD group in the over 9 day.and its duration of mechanical ventilation and ICU LOS were significantly lower than those of SSD group and control group.However,there was no significant difference of VAP related death rate among the three groups. Conclusion Strictly implement semi-supine position and oropharynx intervention strategies of each link in mechanical ventilation that has important significance to preventing ventilator-associated pneumonia.