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目的研究气管导管气囊上行痰热清注射液冲洗对抑制机械通气患者气道病原菌,预防呼吸机相关性肺炎(VAP)的作用。方法对ICU收治的72例气管导管机械通气患者常规对症治疗,随机分为对照组Ⅰ、Ⅱ及试验组各24例,对照组Ⅰ应用无菌生理盐水每12h行1次气囊冲洗,对照Ⅱ组不进行气囊冲洗,试验组用痰热清注射液10ml行同样的气囊冲洗,持续治疗观察15d;检测患者气管导管囊滞留物及下呼吸道分泌物的病原菌分布,统计各组VAP发生、机械通气及住ICU时间。结果治疗15d后,试验组患者囊滞留物中铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌检出率为16.67%、12.50%、8.33%与治疗前54.17%、41.67%、29.17%比较均明显减少,且均显著低于对照组Ⅰ、Ⅱ,差异均有统计学意义(P<0.05);下呼吸道分泌物中铜绿假单胞菌、鲍氏不动杆菌的检出率为8.33%、4.17%与治疗前45.83%、29.17%比较明显减少,且试验组病原菌检出株数均显著低于对照组Ⅰ、Ⅱ,差异有统计学意义(P<0.05);试验组发生VAP例数均明显少于对照组Ⅰ、Ⅱ,患者机械通气天数及入住ICU天数均比对照组Ⅰ、Ⅱ有显著下降,差异有统计学意义(P<0.05)。结论痰热清注射液进行气管导管气囊冲洗能减少机械通气患者气道病原菌生存,降低VAP发生率。
Objective To study the effect of the Tanreqing injection of ascending tracheal tube balloon on inhibiting airway pathogens and preventing ventilator associated pneumonia (VAP) in patients with mechanical ventilation. Methods Seventy two patients with ICU admitted to ICU underwent routine symptomatic treatment and were randomly divided into control group Ⅰ and Ⅱ and experimental group 24 cases each. In control group Ⅰ, balloon flushing was performed every 12 hours with sterile saline and group Ⅱ In the experimental group, the same balloon was rinsed with 10 ml of Tanreqing Injection for 15 days. The distribution of pathogenic bacteria in tracheal catheter retentate and lower respiratory tract secretions was measured. VAP occurrence, mechanical ventilation and ICU live time. Results After 15 days of treatment, the detection rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae in the cystic retentate in the test group were 16.67%, 12.50% and 8.33%, respectively, compared with 54.17% and 41.67% before treatment, (P <0.05). The detection rates of Pseudomonas aeruginosa and Acinetobacter baumannii in lower respiratory tract secretions were significantly lower than those in control group (P <0.05) (P <0.05). The incidence of VAP in experimental group was 8.33%, 4.17% and 45.83% and 29.17% before treatment, and the number of pathogens detected in test group was significantly lower than that in control group Ⅰ and Ⅱ The number of cases were significantly less than the control group Ⅰ, Ⅱ, the number of days of mechanical ventilation and ICU days were significantly lower than the control group Ⅰ, Ⅱ, the difference was statistically significant (P <0.05). Conclusion Tanreqing injection of tracheal catheter balloon airway can reduce the survival of airway pathogens in patients with mechanical ventilation and reduce the incidence of VAP.