摘要
目的研究ICU慢性危重症机械通气依赖患者呼吸机内部回路病原菌污染情况,比较不同呼吸机内部回路消毒方法的疗效评价。方法选取2017年1月~2019年1月杭州市老年病医院收治的慢性危重症机械通气依赖患者及其使用的呼吸机69例为研究对象并分为两组,对呼吸机内部回路进行采样及培养,观察不同时间段病原菌生长情况,研究组患者的呼吸机使用呼吸机内部回路消毒机气体臭氧进行消毒,对照组患者的呼吸机使用75%酒精浸泡消毒,比较两种消毒方法的疗效及对患者呼吸机相关性肺炎发生率、临床肺部感染评分的影响。结果呼吸机内部回路大量病原菌生长,呼气端污染较吸气端明显,病原菌数量与机械通气时间呈正相关。病原菌培养鉴定以革兰阴性菌杆菌为主,部分呼吸机内部回路培养出革兰阳性球菌及真菌。使用呼吸机内部回路消毒机气体臭氧及75%酒精消毒对呼吸机内部回路进行消毒,消毒后病原菌菌落数均显著下降,有统计学差异(P<0.05),两种消毒方法疗效对比无统计学差异(P>0.05),两组患者临床肺部感染评分和呼吸机相关性肺炎发生率比较无统计学差异(P>0.05)。结论呼吸机内部回路病原菌污染严重,呼吸机内部回路消毒机气体臭氧消毒疗效确切,对比75%酒精消毒疗效无统计学差异,两组患者临床肺部感染评分和呼吸机相关性肺炎发生率没有统计学差异,为呼吸机内部回路消毒提供新型有效的消毒方法。
Objective To study the pathogenic bacteria pollution of ventilator internal circuit in ICU patients with chronic critical illness dependent on mechanical ventilation,and to compare the efficacy of different disinfection methods of ventilator internal circuit.Methods 69 chronic critical patients with mechanical ventilation dependence and their respirators in Hangzhou Geriatric Hospital from January 2017 to January 2019 were selected as the research subjects and were divided into two groups.The internal circuit of the ventilator was sampled and cultured to observe the growth of pathogenic bacteria in different periods of time.The respirators in the study group were sterilized with ozone,which was the disinfection gas of the internal circuit of the ventilator.The ventilator of control group was sterilized by 75%alcohol immersion,and the efficacy,the incidence of ventilator-associated pneumonia and pulmonary infection score of the two methods was compared.Results A large number of pathogens grew in the internal circuit of the ventilator,with more contamination in the expiratory end than that in the inspiratory end.The number of pathogens was positively correlated with the time of mechanical ventilation.Gram negative bacilli were the main pathogens,and gram positive cocci and fungi were cultured in the inner circuit of partial respirators.The number of pathogenic bacteria decreased significantly(P<0.05)after using ozone and 75%alcohol to disinfect the internal circuit of ventilator.There was no statistical difference between the two methods(P>0.05).There was no statistical difference in clinical pulmonary infection score and incidence of ventilator-associated pneumonia between the two groups(P>0.05).Conclusion The internal circuit of the ventilator is seriously polluted by pathogenic bacteria,and the efficacy of ozone disinfection of the internal circuit of the ventilator is proved.There is no statistical difference in the efficacy between 75%alcohol disinfection and ozone disinfection.There is no statistical difference in the clinical pulmonary infection score and the incidence of ventilator-associated pneumonia between the two groups.It provides a new and effective disinfection method for the internal circuit of the ventilator.
作者
裘凯
顾南媛
曾龙欢
熊晓炜
田福
陈辉
郑永科
QIU Kai;GU Nanyuan;ZENG longhuan;XIONG Xiaowei;TIAN Fu;CHEN Hui;ZHENG Yongke(Department of Critical Medicine,Hangzhou Geriatric Hospital,Hangzhou310022,China)
出处
《中国现代医生》
2019年第36期125-129,共5页
China Modern Doctor
基金
浙江省医药卫生科研项目（2019KY535）
关键词
呼吸机内部回路
消毒
慢性危重症
呼吸机相关性肺炎
Ventilator internal circuit
Disinfection
Chronic critical illness
Ventilator-associated pneumonia
