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    重症监护病房呼吸机管道中冷凝水清理时间对呼吸道细菌感染的影响

    Effect of condensate clearance time on bacterial infection of respiratory tract in respiratory pipeline of intensive care unit

    • 摘要: 目的 探讨重症监护病房(ICU)呼吸机管道中冷凝水清理时间对呼吸道细菌感染的影响。方法 收集滁州市中西医结合医院ICU收治的机械通气大于48 h的患者96例,随机分为6 h组、12 h组,每组48例,分别于机械通气后每6 h、12 h时清理呼吸管道中的冷凝水。比较2组冷凝水中的细菌污染率和污染的病原菌,同时分析2组患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率。采用多因素Logistics回归分析冷凝水污染的危险因素和VAP的危险因素。结果 6 h组冷凝水污染率显著低于12 h组(14.58% vs. 56.25%, P<0.01)。冷凝水中主要细菌为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌。6 h组患者VAP发生率显著低于12 h组(4.17% vs. 20.83%, P<0.05)。6 h组和12 h组冷凝水中病原菌与患者感染病原菌一致率分别为100%和90%。冷凝水清理时间是呼吸机管道中冷凝水污染的危险因素(P<0.01)。冷凝水清理时间、冷凝水污染和入院时APPACHEⅡ评分是VAP的危险因素(P<0.01)。结论 ICU呼吸机管道中冷凝水污染时间集中在6~12 h,应每6 h清理冷凝水,可有效降低ICU患者VAP发生率。

       

      Abstract: Objective To investigate the effect of clearance time of condensate in ventilator pipes of intensive care unit (ICU) on bacterial infection of respiratory tract. Methods A total of 96 patients with mechanical ventilation for more than 48 h in ICU of Chuzhou Integrated Hospital of Traditional Chinese and Western Medicine were randomly divided into 6 h group and 12 h group, with 48 patients in each group. The condensate in the respiratory pipeline was cleaned up every 6 h (6 h group) or 12 h (12 h group) after mechanical ventilation. The bacterial contamination rate of condensate and pathogenic bacteria in condensate of the two groups were compared, and the incidence of ventilator associated pneumonia (VAP) in the two groups was analyzed. Multivariate logistic regression was used to analyze the risk factors of condensate pollution and VAP. Results The contamination rate of condensate in the 6 h group was significantly lower than that in the 12 h group (14.58% vs. 56.25%, P<0.01). The main bacteria in the condensate were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. The incidence of VAP in the 6 h group was significantly lower than that in the 12 h group (4.17% vs. 20.83%, P<0.05). The coincidence rate of pathogenic bacteria in condensate with pathogenic bacteria in patients in 6 h group and 12 h group was 100% and 90%, respectively. Condensate cleaning time was a risk factor for condensate pollution in ventilator pipelines (P<0.01). Condensate cleaning time, condensate pollution and APPACHE II score at admission were risk factors for VAP (P<0.01). Conclusions The condensate pollution in the ventilator pipeline of ICU patients mainly occurs at 6-12 h, and the condensate should be cleaned every 6 h, which can effectively reduce the incidence of VAP in ICU patients.

       

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