两种气管切开方法与呼吸机相关性肺炎和手术部位感染的比较。

Comparison of Ventilator-Associated Pneumonia and Surgical Site Infection between Two Methods of Tracheostomy.

机构信息

The Nursing Department, The Second Affiliated Hospital of Guangdong Medical University, China.

Department of Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, China.

出版信息

Comput Math Methods Med. 2022 Jul 15;2022:3186634. doi: 10.1155/2022/3186634. eCollection 2022.

DOI:10.1155/2022/3186634

PMID:35872939

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9307366/

Abstract

OBJECTIVE

To compare the incidence of ventilator-associated pneumonia (VAP) and surgical site infection (SSI) between percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST).

METHODS

Data on 487 patients undergoing tracheostomy between 1 January 2014 and 30 September 2020 were reviewed. Patients were divided according to the surgical techniques. Clinical characteristics and postoperative care were compared to explore the risk factors for SSI and VAP. All tracheostomies were performed by intensivists who had completed at least ten tracheostomies. ST was performed using standard techniques. PDT was performed according to a modification technique described by Ciaglia. All procedures were performed at the bedside in the ICU.

RESULTS

Of all, 344 patients (70.6%) were men and 143 (29.4%) were women, and the mean age was 56 years (standard derivation [SD] 12 years). Two hundred and sixty-six patients (54.6%) received PDT, and 221 (45.4%) received SY. Patients in the PDT group had a significantly lower rate of SSI (3.4% vs. 8.5%, = 0.01) compared with the ST group. Multivariate analysis revealed that comorbidities ( = 0.003), surgical type ( = 0.01), and cluster nursing ( < 0.001) were independent risk factors for SSI; age ( = 0.005), comorbidities ( < 0.001), smoking ( = 0.008), and cluster nursing ( = 0.01) were independent risk factors for VAP.

CONCLUSION

PDT significantly reduces the risk of SSI. Proper care should be administrated in patients with one or more risk factors of SSI or VAP to prevent the occurrence of complications.

摘要

目的

比较经皮扩张气管切开术（PDT）与外科气管切开术（ST）在呼吸机相关性肺炎（VAP）和手术部位感染（SSI）发生率方面的差异。

方法

回顾了 2014 年 1 月 1 日至 2020 年 9 月 30 日期间接受气管切开术的 487 例患者的数据。根据手术技术将患者分为两组。比较临床特征和术后护理，以探讨 SSI 和 VAP 的危险因素。所有气管切开术均由至少完成 10 例气管切开术的重症监护医师进行。ST 采用标准技术进行。PDT 根据 Ciaglia 描述的改良技术进行。所有操作均在 ICU 床边进行。

结果

所有患者中，344 例（70.6%）为男性，143 例（29.4%）为女性，平均年龄为 56 岁（标准差[SD]为 12 岁）。266 例（54.6%）患者接受 PDT，221 例（45.4%）接受 ST。PDT 组 SSI 发生率明显低于 ST 组（3.4% vs. 8.5%， = 0.01）。多因素分析显示，合并症（ = 0.003）、手术类型（ = 0.01）和集束护理（ < 0.001）是 SSI 的独立危险因素；年龄（ = 0.005）、合并症（ < 0.001）、吸烟（ = 0.008）和集束护理（ = 0.01）是 VAP 的独立危险因素。