| 摘要: |
| 目的：分析儿科重症监护室（PICU）机械通气管路细菌定植结果，并进一步探讨呼吸机相关小儿肺炎的预防措施。方法：选取2018年1月至10月我院PICU病房行机械通气的患儿164例，采集患儿下呼吸道及呼吸机管路不同部位（包括螺纹管进出口端、进出气端冷凝水、Y型接口处、湿化罐口处）标本进行细菌培养，观察呼吸机相关小儿肺炎发生率、下呼吸道及呼吸机管路的细菌培养结果及细菌分布情况。结果：164例PICU患儿呼吸机相关肺炎发生率为17.07%（28/164）；不同PICU机械通气时间的呼吸机相关小儿肺炎发生率比较，机械通气时间越长，呼吸机相关小儿肺炎发生率越高（P<0.05）；机械通气0~3 d、4~7 d和>7 d患儿的下呼吸道细菌培养阳性率依次升高（P<0.05）；螺纹管进出口端和湿化罐口处的细菌定植培养阳性率均显著低于进出气端冷凝水和Y型接口处（P<0.05）；下呼吸道定植培养出细菌142株（49.13%），呼吸机管路定植培养出147株（50.87%），符合率为96.60%（142/147）；下呼吸道及呼吸机管路培养出细菌均以革兰阴性菌占比最高，占55.71%，其中下呼吸道培养出76株（26.30%），呼吸机管路培养出85株（29.41%），符合率为89.41%；下呼吸道定植培养结果与呼吸机管路定植结果呈正相关（r=0.914，P<0.05）。结论：下呼吸道及呼吸机管路培养出细菌情况基本一致，提示PICU呼吸机相关小儿肺炎的发生与呼吸机管路中的细菌定植情况关系密切，临床应尽早使患儿脱离呼吸机，注重机械通气管路消毒工作，方可有效预防PICU呼吸机相关小儿肺炎的发生。 |
| 关键词: 儿科重症监护室 机械通气管路 细菌定植 呼吸机相关肺炎 儿童 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.01.006 |
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| 基金项目: |
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| Analysis of Bacterial Colonization Results in Mechanical Ventilation Pipeline in Pediatric Intensive Care Unit and Prevention of Ventilator-Associated Pneumonia |
| Liu Xuanxuan, Zhang Chuanling |
| (Xuzhou Children’s Hospital, Jiangsu Xuzhou 221000, China) |
| Abstract: |
| Objective: To analyze the bacterial colonization results in mechanical ventilation pipeline in pediatric intensive care unit (PICU), and to further explore the preventive measures of ventilator-associated pneumonia (VAP) in children. Methods: Totally 164 children with mechanical ventilation in PICU from Jan. to Oct. 2018 were extracted. The samples of different parts of lower respiratory tract and ventilator pipeline (including inlet and outlet of threaded tube, condensate at inlet and outlet of inlet and outlet air, Y-junction and humidification tank mouth) were collected for bacterial culture. The incidence of VAP in children, results of bacterial culture and bacterial distribution in lower respiratory tract and ventilator pipeline were observed. Results: The incidence of VAP in PICU was 17.07%(28/164). The longer the mechanical ventilation, the higher the incidence of VAP in children (P<0.05). The positive rate of bacteria culture in the lower respiratory tract of children with mechanical ventilation at 0~3 d, 4~7 d and >7 d increased successively (P<0.05). The positive rate of bacterial culture at the inlet and outlet of the threaded tube and at the mouth of the wetting tank was significantly lower than that at the condensate water and Y-junction of the inlet and outlet (P<0.05). Totally 142 strains (49.13%) of bacteria were cultured in the lower respiratory tract, 147 strains (50.87%) were cultured in the ventilator pipeline, and the coincidence rate was 96.60% (142/147). Gram-negative bacteria accounted for the highest proportion of bacteria cultured in the lower respiratory tract and ventilator pipeline, accounting for 55.71%, of which 76 strains (26.30%) were cultured in the lower respiratory tract, and 85 strains (29.41%) were cultured in the ventilator pipeline, with the coincidence rate of 89.41%. The results of lower respiratory tract bacterial colonization were positively correlated with the results of ventilator tube colonization (r=0.914, P<0.05). Conclusion: The bacteria cultured in lower respiratory tract and ventilator pipeline are basically the same, suggesting that the occurrence of VAP in children in PICU is closely related to the bacterial colonization in ventilator pipeline. Clinically, children should be separated from the ventilator as soon as possible, and attention should be paid to the disinfection of mechanical ventilation pipeline, so as to effectively prevent the occurrence of VAP in children in PICU. |
| Key words: pediatric intensive care unit mechanical ventilation pipeline bacterial colonization ventilator-associated pneumonia children |
