【摘要】：目的：探討集束化治療措施對(duì)顱腦疾病患者呼吸機(jī)相關(guān)性肺炎預(yù)后的價(jià)值。方法：選擇2010年9月-2012年3月期間入住我院ICU顱腦疾病的機(jī)械通氣患者72例，隨機(jī)分為對(duì)照組（實(shí)施常規(guī)治療）35例及實(shí)驗(yàn)組（實(shí)施集束化治療）37例。兩組共同給予常規(guī)治療，包括（1）原發(fā)病的治療；（2）保護(hù)重要臟器功能；（3）盡量保持患者床頭抬高，防止墜積性肺炎的發(fā)生；（4）合理使用抗生素；（5）每天進(jìn)行撤機(jī)評(píng)估，盡早撤機(jī)拔管；（6）防止深靜脈血栓；（7）減少院內(nèi)交叉感染；（8）加強(qiáng)病區(qū)及儀器監(jiān)管。除以上治療外，，實(shí)驗(yàn)組包括：（1）每隔6小時(shí)交替給予2%氯已定溶液與4%碳酸氫鈉清潔口咽部；（2）每日應(yīng)用纖維支氣管鏡可視化吸痰，保持氣道清潔干凈；（3）根據(jù)監(jiān)測(cè)患者具體血糖，給予泵入胰島素控制血糖不高于10mmol/L；（4）給予患者泵人咪達(dá)唑侖和嗎啡鎮(zhèn)靜鎮(zhèn)痛，并每天實(shí)施1次喚醒計(jì)劃，盡量減少鎮(zhèn)靜鎮(zhèn)痛時(shí)間。比較實(shí)驗(yàn)組與對(duì)照組在ICU住院時(shí)間，ICU住院費(fèi)用及患者28天死亡率方面之間的差異。結(jié)果：實(shí)驗(yàn)組ICU住院時(shí)間11.93±6.25天，對(duì)照組ICU住院時(shí)間18.08±7.53天(P=0.002)。試驗(yàn)組ICU住院的費(fèi)用試驗(yàn)組:6.87±3.25萬(wàn)元，對(duì)照組:9.58±3.82萬(wàn)元(P=0.007)。結(jié)論：集束化治療措施能夠明顯減少顱腦疾病呼吸機(jī)相關(guān)性肺炎患者的ICU住院時(shí)間、住院費(fèi)用，但不能降低患者的28天死亡率。集束化治療措施的作用是值得肯定的。
[Abstract]:Objective: to investigate the prognostic value of cluster therapy for ventilator-associated pneumonia in patients with craniocerebral diseases. Methods: 72 patients with ICU craniocerebral diseases admitted to our hospital from September 2010 to March 2012 were randomly divided into two groups: control group (n = 35) and experimental group (n = 37). The patients were divided into two groups: control group (n = 35) and experimental group (n = 37). The two groups were given routine treatment, including (1) primary treatment, (2) protection of important organ function, (3) keeping the bedhead of patients as high as possible to prevent the occurrence of falling pneumonia, (4) rational use of antibiotics, and (2) protection of the function of vital organs, (4) rational use of antibiotics. (5) to carry out daily weaning assessment and remove the catheter as soon as possible; (6) to prevent deep venous thrombosis; (7) to reduce hospital cross-infection; and (8) to strengthen the supervision of disease areas and instruments. In addition to the above treatment, the experimental group included: (1) 2% chlorhexidine solution and 4% sodium bicarbonate were given alternately every 6 hours to clean the oropharynx, (2) using fiberoptic bronchoscope to visualize sputum suction every day to keep the airway clean and clean. (3) according to the monitoring of specific blood glucose, insulin was given to control blood glucose of no more than 10 mmol / L; (4) midazolam and morphine were given to pump patients with sedative analgesia, and a wake-up plan was carried out once a day to reduce sedative and analgesic time as much as possible. The differences in hospitalization time of ICU, hospitalization cost of ICU and mortality of 28 days between the experimental group and the control group were compared between the experimental group and the control group. Results: the hospitalization time of ICU in experimental group was 11.93 鹵6.25 days, and that of ICU in control group was 18.08 鹵7.53 days (P < 0.002). The cost of ICU hospitalization in the experimental group was 6.87 鹵32,500 yuan in the test group and 9.58 鹵38,199 yuan in the control group (P < 0.007). Conclusion: cluster therapy can significantly reduce the hospitalization time and cost of ventilator-associated pneumonia (ICU) in patients with craniocerebral diseases, but it can not reduce the 28-day mortality of the patients. The effect of cluster therapy is commendable.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.1

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