作　　者： (洪跃玲）; (杨相梅）;

机构地区： 重庆医科大学附属第一医院呼吸内科,重庆400016

出　　处： 《重庆医科大学学报》 2017年第9期1196-1199,共4页

摘　　要： 目的:探讨呼吸过滤器(breathing filter,BF)在无创机械通气中应用的安全性、必要性和有效性,为临床合理使用提供参考依据。方法:首先选取2015年5月至2015年6月进行无创机械通气的30例患者,在BF分别使用24 h、48 h后,在过滤膜两侧采样并进行细菌检测以评价滤菌效果;再将2015年7月至2016年8月进行无创机械通气的450例患者随机分为A组(未使用BF)、B组(使用BF且每24小时更换)、C组(使用BF且每48 h更换),比较3组患者ICU住院时间、无创机械通气时间、医院获得性肺炎(hospital acquired pneumonia,HAP)感染率、疾病转归以及舒适度。结果:BF使用24 h、48 h后的过滤膜呼吸机侧(P=0.480)、患者侧(P=0.480)细菌检测结果差异无统计学意义;3组患者ICU住院时间[A组(10.604±9.354)d,B组(8.319±5.077)d,C组(9.793±6.807)d,P=0.113]、无创机械通气时间[A组(6.712±5.414)d,B组(6.418±3.996)d,C组(6.980±5.225)d,P=0.599]、HAP感染率(A组4.76%,B组3.47%,C组4.11%,P=0.858)以及疾病转归(好转率、死亡率以及放弃治疗后死亡率分别为A组74.8%、16.3%、7.4%,B组74.3%、12.5%、9.7%,C组80.8%、15.7%、2.0%,P=0.080),差异无统计学意义;B、C两组患者与A组患者舒适度差异有统计学意义(A组5.99±1.37,B组7.35±1.21,C组7.30±1.20,P=0.000)。结论:BF在无创机械通气中使用48 h后亦具有良好的细菌滤过功能;使用BF对无创机械通气患者的住院时间、机械通气时间、HAP感染率、预后等无影响,但能增加患者舒适度,建议在患者知情同意下可使用,使用时可每48小时更换1次,不必每天更换。 Objective：To investigate the safety,necessity and effectiveness of filter breathing（BF）in patients with noninvasive mechanical ventilation,and to provide reference for clinical use. Methods：Thirty cases of noninvasive mechanical ventilation were involved.After the BF being used for 24 hours or 48 hours,bacterial culture sample was collected on both sides of the filter membrane to evaluate the filtration effect. Then 450 cases of noninvasive mechanical ventilation were randomly divided into group A（non BF used）,group B（using BF and replaced every 24 hours）,and group C（using BF and replaced every 48 hours）. ICU stay time,noninvasive mechanical ventilation time,the infection rate of hospital acquired pneumonia,prognosis of the disease and the degree of comfort of three groups were compared. Results：There was no significant difference between the ventilator side（P =0.480） and the patient side（P =0.480）in the filter membrane after BF being used 24 hours or 48 hours. And there was still no significant significant difference in the ICU stay time（P=0.113）,noninvasive mechanical ventilation time（P=0.599）,the infection rate of HAP（P=0.858）and the prognosis of the disease（P=0.080）among three groups. However,the statistic difference of the degree of comfort of three groups was significant（P=0.000）. Conclusion：After being used for 48 hours,BF still has good bacteria filtration function;using BF can improve the degree of comfort and may be replaced every 48 hours.

关 键 词： 呼吸过滤器 无创机械通气 感染