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目的探讨静脉持续泵入咪达唑仑状态下经声门下吸痰在呼吸机相关性肺炎(ventilation-associated pneumonia,VAP)患者治疗中的临床应用价值。方法以2011年1月—2012年12月收治的共60例VAP患者为研究对象,按随机数字表法分为A组、B组、C组各20例。A组给予ICU常规物理治疗,包括翻身、叩背及常规吸痰(患者自主咳嗽基础上经口腔、鼻腔、人工气道声门上),B组给予ICU常规物理治疗包括翻身、叩背及经声门下吸痰,C组给予咪达唑仑持续静脉泵入下施予同B组相同的处理方法。计量资料采用单因素方差分析,多个实验组与一个对照组比较采用最小显著差法,多个实验组之间采用q检验,P<0.05为差异有统计学意义。结果三组患者在治疗后第7天WBC、CRP、PaO2[A组(14.68±5.81)×10~9/L、(68.64±10.68)mg/L、(62.64±8.42)mm Hg(1 mm Hg=0.133 kPa),B组(13.78±4.54)×10~9/L、(72.48±12.13)mg/L、(64.80±8.85)mm Hg,C组(9.86±3.49)×10~9/L、(45.67±9.08)mg/L、(70.98±8.75)mm Hg]测定差异均有统计学意义(均P<0.05),而PaCO2测定差异均无统计学意义(P>0.05)。C组连续1周内吸痰时不良事件发生次数、机械通气天数[(28.38±2.57)次/周、(9.24±2.18)d]均明显低于A组[(38.68±4.87)次/周、(14.56±3.32)d]、B组[(35.45±3.36)次/周、(13.48±2.98)d],差异均有统计学意义(均P>0.05)。结论静脉持续泵入适量咪达唑仑状态下未加重二氧化碳潴留,可增加患者对声门下吸痰的耐受性,二者配合作用下有助于肺内分泌物的排出,有利于VAP患者炎症指标的控制并可缩短机械通气治疗时间。
Objective To investigate the clinical value of subacute submucosal suctioning of sputum with continuous infusion of midazolam in the treatment of patients with ventilator-associated pneumonia (VAP). Methods A total of 60 patients with VAP admitted from January 2011 to December 2012 were divided into A group, B group and C group according to random number table. A conventional physical therapy group received ICU, comprising a stand, and a conventional call-back suction (on the basis of patients with spontaneous coughing oral, nasal, artificial airway through the glottis), group B given ICU conventional physical therapy include stand, and call-back via Supraglottic suction, C group given midazolam continuous intravenous infusion of the same treatment with the B group. The measurement data were analyzed by one-way ANOVA. The least significant difference method was used to compare multiple experimental groups with one control group. Q test was used among multiple experimental groups. P <0.05 was considered as significant difference. Results three groups of patients after treatment on day 7 WBC, CRP, PaO2 [A group (14.68 ± 5.81) × 10 ~ 9 / L, (68.64 ± 10.68) mg / L, (62.64 ± 8.42) mm Hg (1 mm Hg = 0.133 kPa), group B (13.78 ± 4.54) × 10 ~ 9 / L, (72.48 ± 12.13) mg / L, (64.80 ± 8.85) mm Hg, group (9.86 ± 3.49) C × 10 ~ 9 / L, (45.67 ± 9.08) mg / L, (70.98 ± 8.75) mm Hg], respectively (all P <0.05), but there was no significant difference in PaCO2 assay (P> 0.05). Adverse events when group C 1 continuous suction week, days of mechanical ventilation [(28.38 ± 2.57) times / week, (9.24 ± 2.18) d] were significantly lower than in group A [(38.68 ± 4.87) times / week (14.56 ± 3.32) d in group B and (35.45 ± 3.36) / week in group B, (13.48 ± 2.98) d, respectively. All the differences were statistically significant (all P> 0.05). Conclusion unweighted continuous infusion of intravenous midazolam state amount of carbon dioxide retention, increased sputum aspiration of subglottic patient tolerance, the two cooperating helps flush the lung secretions, inflammatory parameters in patients with VAP beneficial Control and can shorten the time of mechanical ventilation treatment.