摘要目的 观察两种声门下滞留物的清除方式对呼吸机相关肺炎发生率的影响.方法 纳入2007年10月至2010年2月间武汉市中心医院行气管插管及机械通气治疗的病例共149例.按随机数字表法将其分为对照组(47例)、间断冲洗组(54例)及持续引流组(48例).3组患者插管前APACHEⅡ评分无明显差异.对照组给予常规的治疗及护理;间断冲洗组在对照组的基础上每4h进行声门下冲洗1次;持续引流组在对照组的基础上给予持续声门下吸引.比较3组患者在插管后30 d内呼吸机相关性肺炎的发生率及病死率,并观察患者对两种清除措施的耐受情况以及并发症.结果 间断冲洗组(7/54,13.0％)、持续引流组(7/48,14.6％)患者早发呼吸机相关性肺炎的发生率明显低于对照组(19/47,40.4％),差异有统计学意义(x2值分别为9.914和7.978,均P＜0.01),但间断冲洗组、持续引流组间差异无明显统计学意义(x2=0.056,P=0.812).3组患者晚发呼吸机相关性肺炎的发生率和病死率差异无统计学意义(P＞0.05).两种清除方法患者耐受均较好.结论 间断声门下冲洗和持续声门下引流清除声门下滞留物均能有效地预防早发呼吸机相关性肺炎.

abstractsObjective To observe the effect of two different ways of subglottic secretion drainage on the incidence of ventilator-associated pneumonia.Methods A total of 149 patients receiving mechanical ventilation from October 2007 to February 2010 in our hospital were enrolled in our study.According to the random number table,they were divided into 3 groups:a control group (47),a intermittent drainage group (54),and a continuous drainage group (48).There was no significant difference in APACHE Ⅱ score before intubation in the patients of the 3 groups.Conventional treatment and care was performed in the control group,while subglottic rinse was performed every 4 h in the intermittent drainage group and continuous aspiration in the continuous drainage group.The incidence and mortality of ventilator-associated pneumonia were compared among groups within 30 days after intubation.The tolerance and complications were observed.Results The incidence rate of early onset ventilator-associated pneumonia in the intermittent drainage group(13.0％) and the continuous drainage group(14.6％) was significantly lower than that in the control group (40.4％),and the difference was statistically significant (x2 =9.914,7.978 ; P =0.002,0.005),but there was no difference between the former 2 groups (x2 =0.056 ; P =0.812).There was no significant difference in the incidence of late-onset ventilator-associated pneumonia or mortality among groups (P ＞ 0.05).Good tolerance of the 2 methods was observed.Conclusion Subglottic secretion drainage by both the intermittent and the continuous methods can efficiently prevent early onset ventilator-associated pneumonia.