新疆医科大学学报

目的探讨有创呼吸机管路系统不同更换周期与呼吸机相关性肺炎(VAP)发生的关系,确定适合的机械通气患者呼吸机管路的更换周期。方法选择96例呼吸衰竭需建立人工气道进行机械通气的患者,采取呼吸机管路及湿化装置,分别间隔3、5、7d更换,分为3d组、5d组、7d组,分别对呼吸机管路的集水杯进行采样和细菌学检测,同时观察3d组患者发生VAP的情况。结果 96例患者中共分离出34 096株病原菌,革兰氏阳性菌6 226株(18%),革兰氏阴性菌27 870株(82%),发生VAP 70例(24.31%)。3d组2 183株(6%),革兰氏阳性菌437株(1%),革兰氏阴性菌1 746株(5%),发生VAP 7例(7.29%);5d组7 753株(23%),革兰氏阳性菌1 383株(4%),革兰氏阴性菌6 370株(19%),发生VAP 15例(15.63%);7d组24 160株(71%),革兰氏阳性菌4 406株(13%),革兰氏阴性菌19 754株(58%),发生VAP 48例(50.00%)。7d组VAP的发病率明显高于3d组、5d组,差异有统计学意义(P<0.05),3d组和5d组比较差异无统计学意义。结论呼吸机管路更换时间与VAP发生率相关,建议7d至少更换1次呼吸机管路,可以降低VAP的发生率。

Objective To study the relationship between different replacement cycle of breathing machine pipeline system and ventilator associated pneumonia(VAP),also determine the suitable mechanical ventilation pipe replacement cycle for patients with ventilator.Methods 96 patients with respiratory failure who need artificial airway to achieve mechanical ventilation used breathing machine line spacing and wetting device.The replacement intervals were three days,five days,7 days respectively.And three groups were established,namely,3-day group,5-day group,7-day group and samples were collected respectively from glasses of breathing machine line set.The bacteriology were observed,and VAP in 3-day group were examined at the same time.Results 34096 strains of pathogenic bacteria from a total 96of patients were isolated,with 6226strains of gram-positive bacteria accounting for 18%,27870 strains of gram-negative bacteria accounting for 82% and 70 cases with VAP,accounting for 72.9%;3-day group had 2183 plants(6%)with 437strains of gram-positive bacteria accounting for 1%,1746 strains of gram-negative bacteria accounting for 5%,7 cases with VAP accounting for 7.29%;5-day group had 7753strains accounting for23%,1383strains of gram-positive bacteria accounting for 4%,6370 strains of gram-negative bacteria accounting for 19% and 15 cases with VAP accounting for 15.63%;among them 7-day group had 24160plants accounting for 71%,4406 strains of gram-positive bacteria accounting for 13%,19754strains of gram-negative bacteria accounting for 58% and 48 cases with VAP accounting for 50%.The incidence of VAP in 7-day group was obviously higher than that of 3-day and 5-day groups,the difference was statistically significant(P <0.05).There was no significant difference between 3-day group and 5-day group.Conclusion The time of breathing machine pipeline replacement was associated with the incidence of VAP.This study suggests that the breathing machine pipeline should be changed once every 7 days at least,to reduce the incidence of VAP.