Objective  To observe the preventive effect of ceftriaxone sodium (CRO) combined with bundle management (BM) on early ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) patients with mechanical ventilation(MV).

Methods  A total of 138 ICU patients treated with MV at Beijing Tongren Hospital affiliated to Capital Medical University were selected from May 2022 to April 2023. According to whether CRO was used, they were divided  into CRO group and non-CRO (NCRO) group, and BM was performed during hospitalization in both groups. The incidence of early VAP, mortality, duration of mechanical ventilation, ICU stay, and total hospital stay were observed and compared between the two groups. In addition, the changes in inflammatory indicators [C-reactive protein (CRP), procalcitonin (PCT), and white blood cell count (WBC)] were compared before and after the intervention (on day 7).

Results  The incidence of early VAP was lower in the CRO group than in the NCRO group (P<0.05). The mortality rate of patients in the CRO group was lower than that in the NCRO group, but the difference was not statistically significant (P>0.05). The duration of mechanical ventilation, length of ICU stay and total hospital stay in the CRO group were shorter than those in the NCRO group (P<0.05). Before treatment, the CRP levels, serum PCT levels, and WBC were not significantly different between the two groups (P>0.05). Compared with before treatment, serum CRP levels, PCT levels and WBC were significantly decreased in the CRO and NCRO groups (P<0.05). In addition, serum CRP, PCT and WBC of the CRO group were lower than the NCRO group on the seventh day, with a statistically significant difference (P<0.05).

Conclusion  CRO combined with BM can reduce the incidence of early VAP in ICU patients undergoing MV, shorten MV time, ICU stay and total hospital stay, and reduce the level of inflammatory response.

1.陈燕, 李冬梅, 赵青, 等. 集束化管理措施对重症医学科呼吸机相关肺炎干预效果[J]. 中国感染控制杂志, 2022, 21(10): 992-999. [Chen Y, Li DM, Zhao Q, et al. The intervention effect of bundled management measures on ventilator-associated pneumonia in critical care medicine[J]. Chinese Journal of Infection Control, 2022, 21(10): 992-999.] DOI: 10.12138/j. issn.1671-9638. 20223077.

2.严颖, 王东丽, 韩美玲, 等. 目标性集束化护理预防机械通气病人呼吸机相关肺炎的效果研究[J]. 全科护理, 2023, 21(27): 3843-3845. [Yan Y, Wang DL, Han ML, et al. A study on the effectiveness of targeted bundle nursing in preventing ventilator-associated pneumonia in mechanically ventilated patients[J]. General Nursing, 2023, 21(27): 3843-3845.] DOI: 10.12104/j. issn.1674-4748.2023.27.026.

3.Dahyot-Fizelier C, Lasocki S, Kerforne T, et al. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial[J]. Lancet Respir Med, 2024, 12(5):375-385. DOI: 10.1016/S2213-2600(23)00471-X.

4.颜穆丹. 三级公立医院护理质量综合评价研究[D]. 北京: 北京协和医学院, 2024. DOI: 10.27648/d. cnki. gzxhu.2023.000662.

5.常晓未, 宁艳, 王磊, 等. 集束化护理在全身麻醉气管插管护理中应用的研究进展[J]. 护理研究, 2021, 35(7): 1226-1228. [Chang XW, Ning Y, Wang L, et al. Research progress on the application of bundle care in general anesthesia tracheal intubation nursing[J]. Nursing Research, 2021, 35(7): 1226-1228.] DOI: 10.12102/j. issn. 1009-6493.2021.07.020.

6.陈俪萍, 付斌, 符小玲, 等. PDCA循环法联合集束化干预对老年急诊ICU患者呼吸机相关肺炎及压力性溃疡的影响[J]. 中国老年学杂志, 2021, 41(9): 1834-1836. [Chen LP, Fu B, Fu XL, et al. The effect of PDCA cycle combined with bundle intervention on ventilator-associated pneumonia and pressure ulcers in elderly emergency ICU patients[J]. Chinese Journal of Gerontology, 2021, 41(9): 1834-1836.] DOI: 10.3969/j. issn.1005-9202.2021.09.014.

7.孙伟, 李波霞, 宋兵. 注射用头孢曲松钠致剂量相关性下肢关节疼痛1例[J]. 中国药师, 2022, 25(10): 1785-1786. [Sun W, Li BX, Song B. A case of dose-related lower limb joint pain caused by injection of ceftriaxone sodium[J]. China Pharmacist, 2022, 25(10): 1785-1786.]DOI: 10.19962/j. cnki. issn1008-049X.2022.10.019.

8.中华医学会重症医学分会. 呼吸机相关性肺炎诊断, 预防和治疗指南（2013）[J]. 中华内科杂志, 2013, 52(6): 20. DOI: 10.3760/cma. j. issn.0578-1426.2013. 06.024.

9.邓伟, 闫静, 吴伶慧, 等. ICU人工气道患者气囊周围微误吸预防及护理的证据总结[J]. 中华护理教育, 2023, 20(7): 870-877. [Deng W, Yan J, Wu LH, et al. Summary of evidence on prevention and nursing of micro aspiration around airbags in ICU artificial airway patients[J]. Chinese Nursing Education, 2023, 20(7): 870-877.] DOI: 10.3761/j. issn.1672-9234.2023.07.018.

10.周靖敏. 针对性护理对重症监护室重症肺炎患者呼吸机撤机成功率及呼吸功能的影响[J]. 基层医学论坛, 2024, 28(9): 92-95. [Zhou JM. The effect of targeted nursing on the success rate of ventilator weaning and respiratory function in critically ill pneumonia patients in the intensive care unit[J]. Grassroots Medical Forum, 2024, 28(9): 92-95.] DOI: 10.19435/j.1672-1721.2024.09.031.

11.何琴, 杨秀琴, 张思德, 等. 集束化护理在矽肺伴Ⅱ型呼吸衰竭机械通气患者中的应用效果[J]. 现代医学与健康研究电子杂志, 2017, 1(9): 114. [He Q, Yang XQ, Zhang SD, et al. The application effect of bundle nursing in mechanically ventilated patients with silicosis and type II respiratory failure[J]. Electronic Journal of Modern Medicine and Health Research, 2017, 1(9): 114.] https://www.cnki.com.cn/Article/CJFDTotal-XYJD201709096.htm.

12.Zhao XX, Xu LX, Yang ZM, et al. Significance of sTREM-1in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study[J]. BMC Infect Dis, 2020, 20(1): 542. DOI: 10.1186/s12879-020-05196-z.

13.黄文辉, 何轶群, 李娟, 等. sTREM-1、Presepsin对儿童脓毒症诊断和预后评估的价值[J]. 中国现代医学杂志, 2021, 31(19): 7-13. [Huang WH, He YQ, Li J, et al. The value of sTREM-1 and Presepsin in the diagnosis and prognosis evaluation of pediatric sepsis[J]. Chinese Journal of Modern Medicine, 2021, 31(19): 7-13.] DOI: 10.3969/j. issn.1005-8982.2021.19.002.

14.黄茂, 王笑咪, 郭微微. 盐酸氨溴索在慢性阻塞性肺疾病临床治疗中的应用价值[J]. 中国现代医生, 2021, 59(13): 33-36. [Huang M, Wang XM, Guo WW. The application value of ambroxol hydrochloride in the clinical treatment of chronic obstructive pulmonary disease[J]. Chinese Modern Doctors, 2021, 59(13): 33-36.] https://www.cnki.com.cn/Article/CJFDTotal-ZDYS202113009.htm.