目的 探讨3种不同护理干预措施预防呼吸机相关性肺炎(VAP)的作用.方法 选择某院重症监护室( ICU)行机械通气治疗患者90例,按入院先后分为3组,即常规组:2007年7-12月患者30例,实施传统呼吸道管理；人工鼻组:2008年1-6月患者30例,在机械通气时使用人工鼻；人工鼻+集束化护理综合干预组:2008年7-12月患者30例,使用人工鼻的同时采取VAP集束化护理干预.比较3组患者机械通气时间、住ICU时间、VAP的发生率及VAP患者病原菌检出情况.结果 人工鼻+集束化护理综合干预组与常规组、人工鼻组相比,可明显缩短患者机械通气时间[(8.83±6.65)d vs (16.17±4.87)d,t=5.43,P=0.00;(8.83±6.65)d vs (12.43±5.27)d,t=2.31,P＜0.05]；与常规组相比,可缩短患者住ICU时间[(9.30±6.20)dvs(14.97±11.35)d,t=2.42,P＜0.05],降低VAP的发生率(常规组43.33％与人工鼻+集束化护理综合干预组16.67％比较,x2=5.08,P＜0.05).VAP患者共检出病原菌27株,其中耐甲氧西林金黄色葡萄球菌(MRSA)占48.15％(13/27),铜绿假单胞菌18.52％(5/27),肺炎克雷伯菌14.81％(4/27),大肠埃希菌7.41％(2/27),光滑假丝酵母菌、白假丝酵母菌、鲍曼不动杆菌各占3.70％(1/27).结论 使用人工鼻+集束化护理综合干预可有效缩短患者机械通气时间及住ICU时间,有利于规范护理操作行为,降低VAP发生率.%Objective To evaluate the effect of three different nursing intervention methods on preventing ventilator-associated pneumonia(VAP). Methods Ninety intensive care unit(ICU) patients with mechanical ventilation were divided into three groups according to the time of admission, 30 cases were performed routine ventilation care (routine group) from July 2007 to December 2007; 30 cases used heat and moisture exchanger (HME group) when receiving ventilation from January 2008 to June 2008; 30 cases used heat and moisture exchanger and received bundle care of nursing (comprehensive intervention group) from July 2008 to December 2008. The days of ventilation and ICU stay, incidence of VAP, and pathogens causing VAP were compared among three groups. Results Compared with routine and HME group, mechanical ventilation time shortened obviously in comprehensive intervention group ([8. 83 ± 6.65]d vs [16.17 ± 4. 87] d, t = 5. 43,P= 0. 00;[8. 83 ± 6. 65] d vs [12. 43 ± 5. 27] d,t = 2. 31 ,P<0. 05); Compared with routine group, time stay in ICU shortened in comprehensive intervention group ([9. 30 ±6. 2()]d vs [14. 97 ± 11. 35] d, t= 2. 42,P<0. 05), and the incidence of VAP declined (16. 67% vs 43. 33%, χ2 = 5. 08, P< 0. 05). Twenty-seven strains of pathogens were isolated from VAP patients, 48.15% (13/27) were methicillin-re- sistant Staphylococcus aureus, 18.52% (5/27) were Pseudumonas aeruginosa, 14. 81% (4/27) were Klebsiella pneumoniae, 7. 41%(2/27) were Escherichia coli, and 3. 70% (1/27) were Candida tropicalis,Candida albicans and Acinetobacter baumannii (1/27) each. Conclusion Heat and moisture exchanger with bundle care intervention can shorten the duration of mechanical ventilation and time in ICU stay, promote standardized nursing practice, and reduce the incidence of VAP.
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