聲門下分泌物引流對呼吸器相關性肺炎效果之評價

Evaluating the effectiveness of intermittent subglottic secretion drainage to prevent ventilator-associated pneumonia

本研究在探討介入性措施聲門下分泌物引流 （subglottic secretion drainage） 是否能降低呼吸器相關性肺炎 （ventilator-associated pneumonia; VAP） 之成效。研究地點為某區域醫院34床內外科加護病房，對象為18歲以上且需插管使用呼吸器者，採雙組前瞻性隨機分派設計，將研究對象分成實驗組與對照組，每組各收120次插管人次。研究對象平均年齡為66.53 ± 16.18歲，男性佔67.6%。至於分組的年齡、性別、加護病房住院天數、使用呼吸器天數、抗生素與制酸劑之使用、疾病嚴重度等，二組均無顯著差異。研究結果顯示，實驗組 VAP 發生率5%（6人次），對照組則為5.83%（7人次）。比較 VAP 發生時間，在實驗組為使用呼吸器後第10.67 ± 5.75天，對照組則為第 7 ± 1.73天。雖然 SSD 能延遲 VAP 的發生，也未達到顯著之統計差異。研究進一步發現，發生 VAP 確實會延長住院天數（P<0.05），但對死亡結果則沒有影響。本研究可提供加護病房的臨床應用，並做為實證性研究探討成效之參考。（感控雜誌2008;18:349-55）。

The purpose of this study was to determine the effectiveness of intermittent subglottic secretions drainage (SSD) as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP). The study was conducted in a 34-bed intensive care unit (ICU) of a regional hospital. During the study period, patients who were >18 years old and required mechanical ventilation were included in this prospective and randomized study. The study group (use of SSD) comprised 120 patients and control group (without the use of SSD) also comprised 120 patients. The mean age was 66.53 ± 16.18 years. 67.6% of the patients were male. No significant difference was found between the two groups in terms of demographic characteristics, length of ICU stay or ventilator use, treatment of antibiotics and antacid drugs, and severity of illness. Occurrence of VAP was seen in 6 patients (5.0%) in the study group and in 7 patients (5.83%) in the control group. YAP occurred later among patients receiving SSD (10.67 ± 5.75 days vs.7 ± 1.73 days) but it did not reach statistical difference. Patients with YAP had a significantly longer ICU stay (p<0.05), but the mortality rate was not affected. (Infect Control J 2008; 18:349-55).