咪达唑仑联合声门下吸痰对呼吸机相关性肺炎的临床价值

目的探讨静脉持续泵入咪达唑仑状态下经声门下吸痰在呼吸机相关性肺炎(ventilation-associated pneumonia,VAP)患者治疗中的临床应用价值。方法以2011年1月—2012年12月收治的共60例VAP患者为研究对象,按随机数字表法分为A组、B组、C组各20例。A组给予ICU常规物理治疗,包括翻身、叩背及常规吸痰(患者自主咳嗽基础上经口腔、鼻腔、人工气道声门上),B组给予ICU常规物理治疗包括翻身、叩背及经声门下吸痰,C组给予咪达唑仑持续静脉泵入下施予同B组相同的处理方法。计量资料采用单因素方差分析,多个实验组与一个对照组比较采用最小显著差法,多个实验组之间采用q检验,P0.05为差异有统计学意义。结果三组患者在治疗后第7天WBC、CRP、PaO2A组(14.68±5.81)×10~9/L、(68.64±10.68)mg/L、(62.64±8.42)mm Hg(1 mm Hg=0.133 kPa),B组(13.78±4.54)×10~9/L、(72.48±12.13)mg/L、(64.80±8.85)mm Hg,C组(9.86±3.49)×10~9/L、(45.67±9.08)mg/L、(70.98±8.75)mm Hg]测定差异均有统计学意义(均P0.05),而PaCO2测定差异均无统计学意义(P0.05)。C组连续1周内吸痰时不良事件发生次数、机械通气天数(28.38±2.57)次/周、(9.24±2.18)d]均明显低于A组(38.68±4.87)次/周、(14.56±3.32)d]、B组(35.45±3.36)次/周、(13.48±2.98)d],差异均有统计学意义(均P0.05)。结论静脉持续泵入适量咪达唑仑状态下未加重二氧化碳潴留,可增加患者对声门下吸痰的耐受性,二者配合作用下有助于肺内分泌物的排出,有利于VAP患者炎症指标的控制并可缩短机械通气治疗时间。

Clinical value of midazolam combined with subglottic suctioning in ventilator-associated pneumonia

Objective To study the clinical value of continuous intravenous infusion of midazolam combined with subglottic suctioning in treating ventilator-associated pneumonia（VAP）.Methods A total of 60 cases of VAP treated in our hospital were selected as the research objects from January 2011 to December 2012.They were randomly divided into group A,B and C,20 cases for each group.Group A was given conventional ICU physiotherapy,including turning the body over,knocking the back and conventional sputum suction（via the oral cavity,nasal cavity and supraglottic artificial airway in the presence of independent cough）.Group B was given conventional ICU physiotherapy,including turning the body over,knocking the back and subglottic suctioning.Group C received intravenous infusion of midazolam in addition to the same management in group B.Measurement data were processed by one-way ANOVA,multiple experimental groups were compared with control group with least-significant difference method,multiple experimental groups were tested by q test,the result of P0.05 was considered significantly different.Results There was significant difference between the three groups in the value of WBC,CRP and PaO2 on d7 after treatment（P0.05）,while no significant difference in the value of PaCO2（P0.05）.Group A：WBC（14.68±5.81）×109/L,CRP（68.64±10.68）mg/L,PaO2（62.64±8.42） mm Hg（1 mm Hg=0.133 kPa）;group B：WBC（13.78±4.54）×109/L,CRP（72.48±12.13）mg/L,PaO2（64.80±8.85）mm Hg;group C：WBC（9.86±3.49）×109/L,CRP（45.67±9.08） mg/L,PaO2（70.98±8.75）mm Hg.The frequency of adverse events during sputum aspiration in one week and the duration of mechanical ventilation were significantly lower in group C than in group A and B.Group C：（28.38 ±2.57）times per week,（9.24 ±2.18）d;Group A：（38.68 ±4.87）times per week,（14.56 ±3.32）d;Group B：（35.45 ±3.36）time/week,（13.48±2.98）d.The differences were statistically significant（P0.05）.Conclusion Intravenous infusion of proper