【摘要】 目的 探討密閉式吸痰和開放式吸痰兩種方式對預防心胸外科術后機械通氣患者呼吸道感染的效果。 方法 2009年9月－2010年8月，將86例心胸外科術后機械通氣患者隨機分為兩組，試驗組應用密閉式吸痰法，對照組采用開放式吸痰法。觀察兩組患者術后機械通氣治療即刻及至拔出氣管插管后48 h內每日痰培養結果、每4小時監測一次體溫、血常規檢查及胸片結果、呼吸機相關性肺炎（ventilator associated pneumonia，VAP）發生情況。 結果 兩組患者在年齡、性別、病種方面差異均無統計學意義（Pgt;0.05），但痰培養結果陽性率、VAP發生率差異均有統計學意義（Plt;0.05）。兩組發生VAP患者的痰培養病原菌檢出情況:試驗組均為G-菌；對照組以G-菌為主，余者為真菌-白色念珠菌。 結論 密閉式吸痰法預防心胸外科術后機械通氣患者呼吸道感染效果較開放式吸痰法好。G-菌和真菌-白色念珠菌耐藥性強，治療難度大，臨床中應重視呼吸道感染的預防。【Abstract】 Objective To evaluate the effects of closed endotracheal suctioning (CS) and open endotracheal suctioning (OS) on the prevention of respiratory tract infection in mechanically ventilated patients after cardiac surgery. Methods From September 2009 to August 2010, 86 mechanically ventilated patients after cardiac surgery were randomly divided into two groups. CS and OS were provided for patients in the experimental group and the control group, respectively. The sputum culture result, body temperature every four hours, blood routine examination and chest X-ray result, and the development of ventilator-associated pneumonia (VAP) were observed and compared between the two groups at the admission to the ICU and once a day thereafter. Results There were no significant differences between the two groups in sex, age, or kinds of diseases (Pgt;0.05). There were significant differences between the two groups in the positive rate of sputum culture results and the incidence of VAP (Plt;0.05). The pathogens isolation in sputum culture of VAP patients were all Gram-negative bacteria in the experimental group, and mainly Gram-negative bacteria followed by fungi-Blastomyces albicans in the control group. Conclusions CS is more effective than OS in the prevention of respiratory tract infection in mechanically ventilated patients after cardiac surgery. The drug resistance of Gram-negative bacteria and fungi-Blastomyces albicans is b, and the treatments of those bacteria are difficult. Thereafter, we should pay more attention to the prevention of respiratory tract infection.
【摘要】 目的 總結先天性心臟病術后無創通氣的監護。 方法 2008年1-12月胸外ICU 36例先天性心臟病術后患兒，在使用無創通氣前后監測血壓、心率、呼吸及血氣變化。 結果 與無創通氣前相比，無創通氣后30 min、1 h、2 h的指標均恢復到滿意水平，循環穩定。 結論 通過采用無創通氣，80%的患兒避免了再次插管，縮短有創通氣時間，同時避免了相關的呼吸道并發癥，縮短了患兒住院時間，節省了醫療費用，提升了先天性心臟病患兒術后成活率。【Abstract】 Objective To summarize the nursing experience of noninvasive ventilation for infants with congenital heart disease after the surgery. Methods A total of 36 patients who underwent noninvasive ventilation from January to December 2008 were enrolled. The blood pressure, heart rate, respiration, and blood gas were recorded and analyzed before and after noninvasive ventilation. Results Compared with the results before noninvasive ventilation, all of the indexes returned to a satisfying level and the circulation kept stable 30 minutes, one hour, and two hours after noninvasive ventilation. Conclusion Noninvasive ventilation may avoid reintubation, shorten the invasive ventilatory time, decrease the respiratory complications, shorten the time of hospitalization, save the medical expenses, and promote the survival rate of infants with congenital heart disease.