振动排痰机应用于危重症患者呼吸机相关性肺炎治疗中的效果
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摘要
目的探讨振动排痰机应用于危重症患者呼吸机相关性肺炎(VAP)治疗中的效果。方法选取本院于2015年11月～2017年12月收治的56例重症监护病房VAP患者,按随机数字表法分为两组,每组28例,两组均开展积极综合治疗,观察组用震动排痰机排痰,对照组仍采用传统人工叩背方式排痰。记录并比较两组抗生素应用时间、机械通气时间、每日排痰量及抗生素应用时间。在治疗前及治疗第3、5、7天时,记录两组急性生理和慢性健康状(APACHEⅡ)、临床肺部感染(CPIS)评分情况。结果观察组每日排痰量、抗菌素应用时间、机械通气时间均好于对照组(P <0.05);治疗第3、5、7天时,两组APACHEⅡ评分、CPIS评分相比组内治疗前,均有明显好转,各时间点组间比较,差异有统计学意义(P <0.05)。结论针对VAP患者,采用振动排痰机治疗,能有效清除其呼吸道痰液,减少机械通气时间与抗生素使用时间,对控制肺部感染有利,还能改善预后,临床应用价值高。
Objective To explore the curative effect of vibration sputum elimination machine in the treatment of ventilator-associated pneumonia(VAP)in critically ill patients. Methods Fifty-six patients with VAP who were admitted to ICU in our hospital from November 2015 to December 2017 were selected.They were randomly divided into 2 groups according to the number table method,with 28 cases in each group.The two groups were given active comprehensive treatment.The observation group used vibration sputum elimination machine for sputum elimination while the control group used traditional artificial percussion on back method for sputum elimination.Antibiotic application time,mechanical ventilation time,daily sputum elimination volume and antibiotic application time were recorded and compared between the two groups.The scores of acute physiology and chronic health evaluation(APACHE Ⅱ) and clinical pulmonary infection scoring(CPIS) were recorded before treatment and on the 3,5 and 7th day of treatment. Results Daily sputum elimination volume,antibiotic application time and mechanical ventilation time of the observation group were all better than those of the control group(P < 0.05).On the 3,5 and 7th day of treatment,APACHE Ⅱ score and CPIS score of two groups were all significantly improved compared with those before treatment.There were significant differences between the groups at each time point(P < 0.05). Conclusion For patients with VAP,treatment with vibration sputum elimination machine can effectively eliminate sputum in the respiratory tract,reduce mechanical ventilation time and antibiotic application time.It is beneficial to control pulmonary infection and it can also improve the prognosis.The clinical application value is high.
Objective To explore the curative effect of vibration sputum elimination machine in the treatment of ventilator-associated pneumonia(VAP)in critically ill patients. Methods Fifty-six patients with VAP who were admitted to ICU in our hospital from November 2015 to December 2017 were selected.They were randomly divided into 2 groups according to the number table method,with 28 cases in each group.The two groups were given active comprehensive treatment.The observation group used vibration sputum elimination machine for sputum elimination while the control group used traditional artificial percussion on back method for sputum elimination.Antibiotic application time,mechanical ventilation time,daily sputum elimination volume and antibiotic application time were recorded and compared between the two groups.The scores of acute physiology and chronic health evaluation(APACHE Ⅱ) and clinical pulmonary infection scoring(CPIS) were recorded before treatment and on the 3,5 and 7th day of treatment. Results Daily sputum elimination volume,antibiotic application time and mechanical ventilation time of the observation group were all better than those of the control group(P < 0.05).On the 3,5 and 7th day of treatment,APACHE Ⅱ score and CPIS score of two groups were all significantly improved compared with those before treatment.There were significant differences between the groups at each time point(P < 0.05). Conclusion For patients with VAP,treatment with vibration sputum elimination machine can effectively eliminate sputum in the respiratory tract,reduce mechanical ventilation time and antibiotic application time.It is beneficial to control pulmonary infection and it can also improve the prognosis.The clinical application value is high.
引文
[1]黄玉凤.循证护理在重型颅脑损伤患者呼吸机相关性肺炎治疗中的临床应用[J].深圳中西医结合杂志,2014,24(4):142-143.
[2]应利君,吕铁,李智鑫,等.氨溴索联合振动排痰机治疗呼吸机相关性肺炎的疗效[J].中华老年医学杂志,2014,33(8):871-873.
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[4]储小燕,闫婧.机械振动排痰在减少外科术后ICU机械通气患者肺部并发症的应用[J].实用临床医药杂志,2017,21(16):169-171.
[5]Gaeta M.,Ascenti G.,Mazziotti S.,et al.MRI differentiation of pneumonia-like mucinous adenocarcinoma and infectious pneumonia[J].European Journal of Radiology,2012,81(11):3587-3591.
[6]Abeyratne U.R.,Swarnkar V.,Setyati A.,et al.Cough sound analysis can rapidly diagnose childhood pneumonia[J].Annals of Biomedical Engineering:The Journal of the Biomedical Engineering Society,2013,41(11):2448-2462.
[7]陈文强.呼吸机相关性肺炎防治进展[J].中外医学研究,2018,16(5):186-188.
[8]许可.高频胸壁振荡排痰系统对ICU机械通气患者排痰效果的影响[J].吉林医学,2016,37(8):2062-2064.
[9]李英,齐见旭.高频胸壁振荡排痰系统在ICU有创机械通气排痰中的应用及效果[J].微创医学,2016,11(2):174-176.
[10]徐华,陈美琴.振动排痰法与叩背排痰法预防重型颅脑损伤呼吸机相关性肺炎的对照研究[J].浙江实用医学,2016,21(6):446-447.
[11]王伯丽,叶丽云,李帅,等.间断大潮气量治疗联合呼气相胸廓按压技术在有创机械通气患者中的应用价值[J].广东医学,2015,36(24):3889-3891.
[12]Johkoh T.,Sumikawa H.,Fukuoka J.,et al.Do you really know precise radiologic-pathologic correlation of usual interstitial pneumonia?[J].European Journal of Radiology,2014,83(1):20-26.
[13]曾慧,张珍,龚媛,等.胸肺物理治疗用于机械通气患者的疗效:一项前瞻性随机对照研究[J].中华危重病急救医学,2017,29(5):403-406.
[14]王伯丽,苏海波,张鲁涛,等.有创机械通气治疗中间断大潮气量与呼气相胸廓按压技术的应用[J].山东医药,2016,56(3):90-92.
[15]储小燕,闫婧.机械振动排痰在减少外科术后ICU机械通气患者肺部并发症的应用[J].实用临床医药杂志,2017,21(16):169-171.
[16]陈芹.氨溴索联合振动排痰机治疗呼吸机相关性肺炎效果观察[J].中国乡村医药,2015,22(23):3-4.
[2]应利君,吕铁,李智鑫,等.氨溴索联合振动排痰机治疗呼吸机相关性肺炎的疗效[J].中华老年医学杂志,2014,33(8):871-873.
[3]周正,任爱兰,钟节波.振动排痰法护理预防重型颅脑损伤患者呼吸机相关性肺炎的观察[J].全科医学临床与教育,2016,14(5):593-595.
[4]储小燕,闫婧.机械振动排痰在减少外科术后ICU机械通气患者肺部并发症的应用[J].实用临床医药杂志,2017,21(16):169-171.
[5]Gaeta M.,Ascenti G.,Mazziotti S.,et al.MRI differentiation of pneumonia-like mucinous adenocarcinoma and infectious pneumonia[J].European Journal of Radiology,2012,81(11):3587-3591.
[6]Abeyratne U.R.,Swarnkar V.,Setyati A.,et al.Cough sound analysis can rapidly diagnose childhood pneumonia[J].Annals of Biomedical Engineering:The Journal of the Biomedical Engineering Society,2013,41(11):2448-2462.
[7]陈文强.呼吸机相关性肺炎防治进展[J].中外医学研究,2018,16(5):186-188.
[8]许可.高频胸壁振荡排痰系统对ICU机械通气患者排痰效果的影响[J].吉林医学,2016,37(8):2062-2064.
[9]李英,齐见旭.高频胸壁振荡排痰系统在ICU有创机械通气排痰中的应用及效果[J].微创医学,2016,11(2):174-176.
[10]徐华,陈美琴.振动排痰法与叩背排痰法预防重型颅脑损伤呼吸机相关性肺炎的对照研究[J].浙江实用医学,2016,21(6):446-447.
[11]王伯丽,叶丽云,李帅,等.间断大潮气量治疗联合呼气相胸廓按压技术在有创机械通气患者中的应用价值[J].广东医学,2015,36(24):3889-3891.
[12]Johkoh T.,Sumikawa H.,Fukuoka J.,et al.Do you really know precise radiologic-pathologic correlation of usual interstitial pneumonia?[J].European Journal of Radiology,2014,83(1):20-26.
[13]曾慧,张珍,龚媛,等.胸肺物理治疗用于机械通气患者的疗效:一项前瞻性随机对照研究[J].中华危重病急救医学,2017,29(5):403-406.
[14]王伯丽,苏海波,张鲁涛,等.有创机械通气治疗中间断大潮气量与呼气相胸廓按压技术的应用[J].山东医药,2016,56(3):90-92.
[15]储小燕,闫婧.机械振动排痰在减少外科术后ICU机械通气患者肺部并发症的应用[J].实用临床医药杂志,2017,21(16):169-171.
[16]陈芹.氨溴索联合振动排痰机治疗呼吸机相关性肺炎效果观察[J].中国乡村医药,2015,22(23):3-4.