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目的探讨维持气管导管套囊压力恒定在预防呼吸机相关性肺炎(VAP)中的作用。方法选择2015年1月-12月入住重症监护病房(ICU)行气管插管并且机械通气时间>48 h的96例Ⅱ型呼吸衰竭患者为试验组,实施人工气道集束化管理与测压表定时测定并维持导管套囊压力恒定的管理模式,记录初始采用指捏法判断所得到的导管套囊压力,校正初始压力为30 cm H2O(1 cm H2O=0.098 k Pa)后,采用不同间隔时间测量导管套囊的压力并记录。回顾该ICU 2014年1月-12月仅采用人工气道集束化管理的88例同种疾病患者为对照组,分别记录两组机械通气时间、VAP发生时间、ICU住院时间、VAP发病率等。结果试验组患者初始指捏法估测导管套囊压力经压力表测量后结果显示仅11.46%的导管套囊压力介于25~30 cm H2O,82.29%的导管套囊压力>30 cm H2O;采集8、7、6、5、4、3 h不同间隔时间的导管套囊压力值,其压力维持于25~30 cm H2O的比例分别为41.32%、43.75%、64.20%、76.54%、91.13%、91.85%;试验组患者ICU住院时间、机械通气时间短于对照组,组间对比差异有统计学意义(t=4.171,P<0.001;t=4.061,P<0.001);试验组VAP患者的发病时间晚于对照组,差异有统计学意义(t=2.247,P=0.032)。结论指捏法经验性估测气管导管套囊压力存在较大误差,采用测压表监测套囊压力的推荐间隔时间为4 h,采用人工气道集束化管理联合测压表定时测定并维持导管套囊压力恒定的管理模式,可以缩短患者ICU住院时间、机械通气时间,延迟VAP的发生。
Objective To investigate the effect of maintaining a constant pressure in the tracheal tube cuff on the prevention of ventilator-associated pneumonia (VAP). Methods 96 patients with type Ⅱ respiratory failure admitted to intensive care unit (ICU) with tracheal intubation and mechanical ventilation> 48 h from January to December 2015 were selected as the experimental group. The artificial airway bundle management and manometry The catheter cuff pressure was constantly measured and maintained at a constant management mode. The catheter cuff pressure recorded at the beginning was recorded by finger-pinch method. After adjusting the initial pressure to 30 cm H2O (1 cm H2O = 0.098 kPa) Measure the catheter cuff pressure and record. Review The ICU 88 patients with the same type of disease managed by artificial airway assembly between January 2014 and December 2014 were selected as the control group, and the mechanical ventilation time, VAP occurrence time, ICU hospitalization time and the incidence of VAP were recorded. Results In the test group, the initial finger-pinch method was used to estimate the catheter cuff pressure measured by the pressure gauge. The results showed that only 11.46% of catheter cuff pressures were between 25-30 cm H2O and 82.29% of catheter cuff pressures> 30 cm H2O. The pressure values of catheter cuffs at different time intervals were 41.32%, 43.75%, 64.20%, 76.54%, 91.13% at 8, 7, 6, 91.85%. The length of hospital stay and the duration of mechanical ventilation in the experimental group were shorter than those in the control group. There was significant difference between the two groups (t = 4.171, P <0.001; t = 4.061, P <0.001) The time was later than the control group, the difference was statistically significant (t = 2.247, P = 0.032). Conclusions: There is a big error in the empirical evaluation of the catheterization cuff pressure by the pinch method. The recommended interval time for monitoring the cuff pressure with the manometer is 4 h. The artificial airway bundle management and pressure gauge are used to measure and maintain the catheter The cuff pressure constant management mode, can shorten the patient ICU hospitalization time, mechanical ventilation time, delay the occurrence of VAP.