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目的探讨封闭式吸痰能否降低新生儿呼吸窘迫综合征(RDS)患儿呼吸机相关性肺炎(VAP)的发生率和住院费用。方法选择2012年1月至2013年12月收入本院新生儿重症监护病房、需要机械通气的RDS患儿,采用配对队列研究,分为观察组和对照组。观察组使用封闭式吸痰管,对照组使用开放式吸痰管,由护士对两组患儿进行吸痰操作,比较两组平均每次吸痰操作时间、VAP发生率,平均机械通气时间、吸痰管费用、住院时间、住院费用和病死率。结果两组患儿各103例,基础疾病一致,观察组平均每次吸痰操作时间短于对照组[(164.2±7.0)s比(227.2±8.4)s],VAP发生率低于对照组(10.7%比16.5%),平均机械通气时间短于对照组[(112.1±40.7)h比(148.1±46.3)h],经人工气道吸痰费用高于对照组[(464.1±28.1)元比(118.0±16.0)元],最终平均住院费用低于对照组[(32 102.1±2595.0)元比(35 174.0±3853.1)元],差异均有统计学意义(P<0.05)。两组患儿病死率差异无统计学意义(6.8%比7.8%,P>0.05)。结论封闭式吸痰较开放式吸痰可有效降低RDS患儿VAP发生率,缩短机械通气时间和住院时间,从而降低总的住院医疗费用,值得推广使用。
Objective To investigate whether closed suctioning can reduce the incidence of ventilator-associated pneumonia (VAP) and hospitalization costs in neonates with respiratory distress syndrome (RDS). Methods From January 2012 to December 2013, children with RDS admitted to our neonatal intensive care unit who needed mechanical ventilation were enrolled in the cohort and divided into observation group and control group. In the observation group, the suction tube was closed, while in the control group, an open suction tube was used. The nurses performed suctioning operation on both groups. The average duration of each suctioning operation, VAP incidence, mean duration of mechanical ventilation, Suction tube costs, length of stay, hospitalization costs, and case fatality rates. Results The incidence of VAP in 103 cases in both groups was the same as that in the control group (P <0.05), and the basal diseases were consistent. The average duration of each sputum suction operation in the observation group was shorter than that in the control group [(164.2 ± 7.0) s vs (227.2 ± 8.4) 10.7% vs 16.5%, mean duration of mechanical ventilation was shorter than that of the control group [(112.1 ± 40.7) h vs (148.1 ± 46.3) h], and the cost of artificial airway aspiration was higher than that of the control group [(464.1 ± 28.1) (118.0 ± 16.0) yuan], and the average hospitalization cost was lower than that of the control group (32 102.1 ± 2595.0 yuan vs 35 174.0 ± 3853.1 yuan). The difference was statistically significant (P <0.05). There was no significant difference in case fatality rate between the two groups (6.8% vs. 7.8%, P> 0.05). Conclusions Closed suction sputum aspiration more than open suction can effectively reduce the incidence of VAP in children with RDS, shorten the duration of mechanical ventilation and hospital stay, thereby reducing the total cost of hospitalization, it is worth promoting the use.