Clinical effect of closed sputum suction combined with mechanical ventilation on ventilator-associated pneumonia in neonates
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摘要:目的 观察密闭式吸痰法联合机械通气治疗新生儿呼吸机相关性肺炎的疗效。方法 选取本院新生儿重症监护病房行机械通气的80例新生儿作为研究对象，利用随机数表法分为2组，各40例。2组患儿均进行机械通气治疗，对照组采取常规吸痰治疗，观察组采取密闭式吸痰法进行治疗，对比2组动脉血气指标、并发症发生情况、病死率、住院时间、住院费用及菌群情况。结果 治疗前, 2组动脉氧分压[p(O2)]及动脉血二氧化氮分压[p(CO2)]水平差异无统计学意义(P>0.05); 治疗后, 2组p(O2)、p(CO2)水平均显著改善，且观察组p(O2)水平显著高于对照组, p(CO2)显著低于对照组，差异有统计学意义(P < 0.05); 2组患儿颅内出血、气道损伤、气漏及病死率差异无统计学意义(P>0.05); 观察组呼吸机相关性肺炎发生率显著低于对照组，住院时间显著短于对照组，住院费用显著低于对照组，菌群数显著少于对照组，差异有统计学意义(P < 0.05); 2组患儿病死率无显著差异(P>0.05)。结论 密闭式吸痰法联合机械通气可有效降低新生儿呼吸机相关性肺炎发生率，缩短患儿机械通气维持时间及住院时间，节约住院费用。Abstract:Objective To observe the effect of closed sputum suction combined with mechanical ventilation in the treatment of neonatal ventilator-associated pneumonia.Methods A total of 80 neonates with mechanical ventilation in neonatal intensive care unit in our hospital were selected as research objects, and were divided into two groups by random number table method, with 40 cases in each group. The patients of two groups were treated with mechanical ventilation, the control group was treated with conventional sputum suction, while the observation group was treated with closed sputum suction. The arterial blood gas index, occurrence of complications, mortality, length of hospital stay, hospitalization expenses and bacterial flora were compared between the two groups.Results Before treatment, there were no significant differences in the levels of arterial partial pressure of oxygen [p(O2)] and nitrogen dioxide [p(CO2)] between the two groups (P>0.05). After treatment, the levels of p(O2) and p(CO2) in the two groups were significantly improved, and the level of p(O2) in the observation group was significantly higher, while the level of p(CO2) was significantly lower than that in the control group (P < 0.05). There were no significant differences in intracranial hemorrhage, airway injury, air leakage and mortality between the two groups (P>0.05); the incidence of ventilator-associated pneumonia in the observation group was significantly lower, and the hospitalization time was significantly shorter, the cost of hospitalization was significantly lower, and the number of bacteria was significantly less than that in the control group (P < 0.05); there was no significant difference in mortality between the two groups (P>0.05).Conclusion Closed sputum aspiration combined with mechanical ventilation can effectively reduce the incidence of neonatal ventilator-associated pneumonia, shorten the duration of mechanical ventilation and hospitalization stay.
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表 1 2组动脉血气指标对比(x±s)
mmHg 组别 p(O2) p(CO2) 治疗前 治疗后 治疗前 治疗后 观察组(n=40) 66.29±2.14 84.35±2.64*# 35.16±1.48 25.09±1.18*# 对照组(n=40) 65.83±2.02 80.02±2.37* 34.87±1.35 29.94±1.23* p(O2): 动脉血氧分压; p(CO2): 动脉血二氧化氮分压。与治疗前相比, *P < 0.05; 与对照组比较, #P < 0.05。 
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表 2 2组呼吸机相关性肺炎发生率及病死率对比[n(%)]
组别 呼吸机相关性肺炎 颅内出血 气道损伤 气漏 死亡 观察组(n=40) 5(12.50)* 0 1(2.50) 1(2.50) 1(2.50) 对照组(n=40) 13(32.50) 1(2.50) 1(2.50) 2(5.00) 3(7.50) 与对照组比较, *P < 0.05。
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表 3 2组菌群数对比[n(%)]
组别 肺炎克雷伯菌 铜绿假单胞菌 大肠埃希菌 鲍曼不动杆菌 嗜麦芽黄单胞菌 白假丝酵母菌 合计 观察组(n=40) 4(10.00) 2(5.00) 0 0 1(2.50) 1(2.50) 8(20.00)* 对照组(n=40) 10(25.00) 2(5.00) 2(5.00) 3(7.50) 0 1(2.50) 18(45.00) 与对照组比较, *P < 0.05。
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