气囊压力监测频率对VAP预防效果的随机对照试验及研究结果

A Randomized Controlled Trial on the Effect of Cuff Pressure Monitoring Frequency in Preventing Ventilator-Associated Pneumonia (VAP) and Its Research Findings

摘要: 目的：探讨不同气囊压力监测频率对机械通气患者呼吸机相关性肺炎(VAP)发生率的影响，并评估高频监测在提高气囊压力达标率及改善临床结局方面的效果。方法：采用前瞻性随机对照试验设计，将120例需机械通气 ≥ 48小时的ICU患者随机分为实验组(每2小时监测一次)和对照组(每8小时监测一次)，每组60例。两组均执行标准化VAP预防措施。比较两组气囊压力达标率、VAP发生率、机械通气时间及ICU住院天数等指标。结果：实验组气囊压力达标率显著高于对照组(87.4% vs. 65.2%, P < 0.001)，压力波动幅度更小(6.4 ± 2.1 cmH₂O vs. 11.7 ± 3.4 cmH₂O, P < 0.001)。实验组VAP发生率为11.7%，明显低于对照组的25.0% (P = 0.045)，调整混杂因素后风险比为0.46 (95%CI: 0.21~0.98)。实验组机械通气时间及ICU住院天数均较对照组缩短(P < 0.05)。结论：提高气囊压力监测频率可显著降低VAP发生率并改善临床预后，其核心机制可能与压力维持稳定、减少误吸风险相关。建议ICU临床实践中适当提高监测频率，特别是在高危患者中实施高频监测策略。

Abstract: Objective: To evaluate the impact of different cuff pressure monitoring frequencies on the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients, and to assess whether high-frequency monitoring improves cuff pressure compliance and clinical outcomes. Methods: A prospective randomized controlled trial was conducted among 120 ICU patients requiring mechanical ventilation for ≥48 hours. Participants were randomly assigned to the experimental group (cuff pressure monitoring every 2 hours) or the control group (monitoring every 8 hours), with 60 patients in each group. Standardized VAP prevention measures were implemented in both groups. Outcomes included cuff pressure compliance, VAP incidence, duration of mechanical ventilation, and ICU length of stay. Results: The experimental group showed significantly higher cuff pressure compliance than the control group (87.4% vs. 65.2%, P < 0.001), with smaller pressure fluctuations (6.4 ± 2.1 cmH₂O vs. 11.7 ± 3.4 cmH₂O, P < 0.001). The incidence of VAP was significantly lower in the experimental group (11.7%) than in the control group (25.0%, P = 0.045), with an adjusted risk ratio of 0.46 (95% CI: 0.21~0.98). Furthermore, the experimental group had shorter mechanical ventilation duration and ICU stay (P < 0.05). Conclusion: Increasing the frequency of cuff pressure monitoring significantly reduces VAP incidence and improves clinical outcomes. The benefits are closely related to better pressure stability and reduced risk of microaspiration. High-frequency monitoring is recommended in ICU practice, especially for high-risk patients.