ICU呼吸机相关性肺炎综合预防及发病机制的研究

来源 :中国医药导报 | 被引量 : 0次 | 上传用户:gym510
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目的探讨综合预防措施在改善会厌清洁度,减少会厌部真菌定植,从而减少呼吸机相关性肺部真菌感染中的价值。方法选取2010年10月~2013年12月梧州市人民医院ICU 58例气管插管患者,将其分为干预组(33例)和对照组(25例)。干预组强化医护人员手卫生管理;采取30°~45°半卧位,给予带有声门下分泌物引流功能的气管导管间歇吸引+鼻饲胃动力药多潘立酮;强化口腔护理、冲注法会厌部保洁,纤支镜下会厌冲洗。对照组仅做常规口腔护理。以干预后10 d作为疗效评价时间点,比较两组患者的会厌清洁度及会厌部定植真菌的变化。结果综合干预措施可明显改善会厌清洁度,经综合措施治疗后干预组会厌清洁度好转率为63.64%(经口插管)和83.33%(经鼻插管),干预组会厌清洁度好转率与对照组比较,差异有统计学意义(P<0.05)。综合措施治疗后干预组会厌部真菌定植阴转率达75.00%(经口插管)和88.89%(经鼻插管),干预组真菌阴转率与对照组比较,差异有统计学意义(P<0.05)。结论保持、改善会厌清洁度,可明显降低气管插管患者继发呼吸机相关性肺部真菌感染之风险。 Objective To explore the value of comprehensive preventive measures in improving the cleanliness of epiglottis and reducing fungal colonies in epiglottis so as to reduce ventilator-associated pulmonary fungal infections. Methods Fifty-eight patients with tracheal intubation in ICU of Wuzhou People’s Hospital from October 2010 to December 2013 were divided into intervention group (n = 33) and control group (n = 25). Intervention group to strengthen hand hygiene management of health care workers; to take 30 ° ~ 45 ° semi-recumbent position to give drainage with subglottic tracheal intermittent attractant + nasogastric gastric motility drug domperidone; oral care to promote epiglottic cleaning, Bronchoscopy epiglottis flushing. Control group only routine oral care. 10 days after intervention as the time point of efficacy evaluation, the tibia cleanliness of the two groups were compared and the epiphyseal colonization of fungal changes. Results The comprehensive interventions significantly improved the cleanliness of the epiglottis. After treatment, the improvement rate of epistaxis was 63.64% (oral intubation) and 83.33% (nasal intubation) The difference between the control group, the difference was statistically significant (P <0.05). After treatment, the rate of negative conversion of fungal in epiglottis group was 75.00% (oral intubation) and 88.89% (nasal intubation) in intervention group. The negative conversion rate of fungus in the intervention group was significantly lower than that in the control group (P <0.05). Conclusions Maintaining and improving the cleanliness of the epiglottis can significantly reduce the risk of subsequent ventilator-associated pulmonary fungal infection in patients with endotracheal intubation.
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