摘要目的观察气囊上滞留物的引流对呼吸机相关性肺炎（VAP）发病的影响。方法将EICU病房82例机械通气患者随机分成气囊上滞留物引流组41例和非引流组41例。定期对两组患者的口咽部、气囊上滞留物和下呼吸道分泌物进行细菌学检测，记录患者机械通气时间、总住院时间、气囊上滞留物的引流量及致病菌浓度、发生 VAP的病例数，依据防污染毛刷采样（PSB）定量培养结果确定 VAP的病原体。结果引流组早发VAP发生率、机械通气时间、总住院时间、患者最后转归等结果明显优于非引流组，且两组相比较差异有显著性（ P ＜0．05）；引流组气囊上滞留物致病菌的浓度明显低于非引流组细菌的浓度，且两组相比较差异有显著性（ P ＜0．05）；气囊上滞留物与下呼吸道病原体有一致性和相似的构成比。结论气囊上滞留物是VAP病原体的重要来源；气囊上滞留物引流方法简便，可降低早发性VAP的发生率，使VAP发生时间延迟，病死率降低，机械通气时间及住院时间缩短。
Abstract：[Objective]To assess the effects of subglottic secretion drainage on the morbidity of ventilator‐associated pneumonia (VAP) in mechanically ventilated patients .[Methods]A total of 84 patients undergoing mechanical ventilation in Emergency Intensive Care Unit (EICU ) were randomly divided into two groups of subglottic secretion drainage (SSD ,n =41) and routine care (non‐SSD ,n=41) .Bacterial culture of samples from oropharynx ,subglottic secretions and lower respiratory tract were obtained periodically .The bacterial a‐mount of subglottic secretion ,ventilation duration ,hospitalization time and count of VAP were recorded .Eti‐ologic diagnosis of VAP was based on the quantitative bacterial culture of secretions obtained by protected specimen brush (PSB) .[Results]Group SSD had a lower rate of early‐onset VAP ,fewer ventilated days ,less hospitalization time and lower mortality rate than those of non‐SDD group ( P <0 .05) .The bacterial amount of subglottic secretion was lower in SDD group than that in non‐SDD group ( P<0 .05) .And the pathogenetic organisms were similar in subglottic secretion and lower respiratory tract .[Conclusion] The presence of sub‐glottic secretion may be an origin of pathogenetic organisms of VAP .SDD may reduce the incidence of VAP and fatality rate ,delay the onset of VAP and shorten mechanical ventilation time .And SSD is a simple and ef‐fective method of preventing VAP .
基金资助:国家临床重点专科建设项目卫办医政函2012(649号)
引用本文:
王煜%刘伟. 气囊上滞留物引流对呼吸机相关肺炎发病的影响[J]. 医学临床研究, 2015, 32(1): 1-4.
WA NG Yu%LIU Wei. Effects of Subglottic Secretion Drainage on the Morbidity of Ventilator-associated Pneumonia in Mechanically Ventilated Patients. JOURNAL OF CLINICAL RESEARCH, 2015, 32(1): 1-4.
2015, Vol. 32 
