综合干预措施对昏迷患者呼吸机相关性肺炎发生率的影响

Influence of comprehensive intervention measures on incidenceof ventilator-associated pneumonia in coma patients

  • 摘要: 目的 探讨昏迷患者呼吸机相关性肺炎(VAP)有效干预措施,以降低VAP的发生率、促进患者康复。方法 选取2014年12月-2015年11月建立人工气道机械通气昏迷患者83例,按随机数字表法分为观察组41例、对照组42例,两组均落实预防呼吸机相关性肺炎常规护理措施;观察组在此基础上采用封闭式吸痰,并根据肺部情况给予纤维支气管镜肺部灌洗,遵医嘱行腹部超声药物透入治疗促进肠蠕动;观察两组返流误吸、VAP发生情况,带呼吸机、住ICU时间。结果 观察组返流误吸、VAP发生率分别为2.44%、4.88%显著低于对照组,观察组机械通气、住ICU时间(8.86±3.54、10.57±3.46)d明显低于对照组差异均有统计学意义(P<0.05)。结论 建立人工气道行机械通气的昏迷患者,采用综合干预措施能有效减少返流导致的误吸,降低VAP发生率,缩短机械通气及住ICU时间,此方法值得临床推广应用。

     

    Abstract: OBJECTIVE To explore the effective intervention measures for the coma patients with ventilator-associated pneumonia(VAP)so as to reduce the incidence of VAP and promote the recovery of the patients.METHODS A total of 83 coma patients who were treated with artificial airway mechanical ventilation from Dec 2014 to Nov2015 were enrolled in the study and randomly divided into the observation group with 41 cases and the control group with 42 cases.The conventional nursing measures were taken for prevention of VAP,the observation group was treated with additional closed sputum suction and was given bronchoalveolar lavage according to the condition of lungs,and the abdominal ultrasonic drug penetration therapy was conducted by following the doctor′s advice so as to promote the intestinal peristalsis.The incidence rates of regurgitation and aspiration,VAP,duration of mechanical ventilation,and length of ICU stay were observed and compared between the two groups of patients.RESULTS The incidence rates of regurgitation and aspiration,VAP of the observation group were respectively 2.44% and 4.88%,significantly lower than those of the control group.The mechanical ventilation duration of the observation group was(8.86±3.54),significantly shorter than that of the control group;the length of ICU stay of the observation group was(10.57±3.46),significantly shorter than that of the control group(P<0.05).CONCLUSION It is an effective way to take the comprehensive intervention measures for the coma patients undergoing the artificial airway mechanical ventilation so as to reduce the incidence rates of regurgitation and aspiration,VAP,and shorten the mechanical ventilation duration as well as the length of ICU stay;the method is worthy to be promoted in the hospital.

     

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