气管内冲洗在新生儿呼吸机相关肺炎中的应用

Application of endotracheal lavage in neonatal ventilator-associated pneumonia

摘要:

目的：探讨气管内冲洗技术在新生儿呼吸机相关肺炎（VAP）中的应用。方法：将2002年1月至2008年12月新生儿VAP 58例，随机分为对照组29例，冲洗组29例。两组撤机后，根据痰培养及药敏结果给予敏感抗生素治疗并加强对症支持处理。冲洗组在对照组治疗的基础上，应用气管内冲洗治疗，每日2~3次。对两组的治疗效果进行比较。结果：对照组平均机械通气时间与冲洗组差异无统计学意义；对照组治疗有效率为69%，冲洗组为93%，差异有统计学意义（P＜0.05）；对照组二次或多次上呼吸机比例为24%，冲洗组为3%（P<0.05）；冲洗组冲洗后2 h的血气分析结果明显优于冲洗前(P＜0.01）。结论：气管内冲洗可以减少患儿机械通气的次数，提高治疗有效率，值得临床推广应用。［中国当代儿科杂志，2010，12（3）：195-197］

Abstract:

OBJECTIVE: To study the efficacy of endotracheal lavage in neonatal ventilator-associated pneumonia (VAP). METHODS: Fifty-eight neonates with VAP between January 2002 and December 2008 were randomly assigned to two groups: lavage and control (n=29 each). After withdrawal from ventilator, both groups received sensitive antibiotics therapy according to sputum culture results as well as supportive treatment. The lavage group was additionally treated with endotracheal lavage (2-3 times daily). The therapeutic effects were compared between the two groups. RESULTS: There were no significant differences in the average time of mechanical ventilation between the lavage and the control groups. The effective rate in the lavage group (93%) was significantly higher than that in the control group (69%; P<0.05). Three percent of patients in the lavage group required twice or more mechanical ventilation compared with 24% in the control group (P<0.05). Blood gas analysis results were obviously improved in the lavage group 2 hrs after treatment (P<0.01). CONCLUSIONS: Endotracheal lavage can decrease the number in mechanical ventilation and improve therapeutic effects in neonates with VAP.［Chin J Contemp Pediatr, 2010, 12 (3):195-197］