【摘要】 目的研究益口含漱液对机械通气(MV)患者呼吸机相关性肺炎(VAP)发生率及细菌学的影响,探讨有效预防VAP的措施。方法对ICU收治的气管插管机械通气患者324例,随机分为对照组、试验组各162例,对照组应用无菌生理盐水进行口腔护理,试验组应用益口含漱液进行口腔护理,均4次/d,疗程10d;插管后每天进行声门下滞留物、气管插管内分泌物细菌学检查,比较两组VAP发生、机械通气及住ICU时间、口腔护理前后口腔细菌培养菌株数。结果 VAP发生率:<4d对照组23.4%、试验组14.8%,4～10d对照组27.2%,试验组17.9%,两组差异有统计学意义(P<0.05);MV时间:对照组(14.2±2.37)d,试验组(8.96±1.09)d,住ICU时间:对照组(15.62±3.06)d,试验组(10.65±2.21)d,两组比较差异均有统计学意义(P<0.05);口腔护理前后口腔内细菌培养病原菌检出数,试验组护理前55株、护理后30株,对照组护理前68株、护理后53株,差异有统计学意义(P<0.05);两组VAP患者下呼吸道细菌培养以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌为主。结论益口含漱液对气管插管MV患者进行口腔护理能降低VAP发生率。更多还原

【Abstract】 OBJECTIVE To explore the effect of Yikou gargle on the incidence of ventilator-associated pneumonia(VAP) in the patients undergoing mechanical ventilation(MV) and the bacteriology so as to propose the effective measures to prevent VAP.METHODS A total of 324 patients undergoing MV in ICU were randomly divided into the control group and the experimental group with 162 cases in each,the control group was treated with oral care with sterile saline 4 times a day,while the experimental group was treated with oral care with Yikou gargle for 4 times a day,the treatment course was 10 days.The secretions from the trachea cannula and the residues in subglottic were sent for bacterial examination.The incidence of VAP,duration of the mechanical ventilation and ICU stay,and the number of oral bacterial cultured strains before and after the oral care were compared between two groups.RESULTS The incidence of VAP in the patients undergoing MV with the duration less than 4 days was 14.8% in the experimental group and 23.4% in the control group,the incidence of VAP in the patients with the duration of MV from 4 days to 10 days was 17.9% in the experimental group and 27.1% in the control group,the differences were statistically significant(P﹤0.05);the duration of MV was(8.96±1.09) days in the experimental group and(14.2±2.37)days in the control group,the duration of ICU stay was(10.65±2.21)days in the experimental group and(15.62±3.06) days in the control group,the differences were statistically significant(P﹤0.05);in the experimental group,there were 55 strains and 30 strains of pathogens isolated respectively before and after the oral nursing,and in the control group,there were 68 strains and 53 strains of pathogens isolated respectively before and after the oral nursing,the differences were statistically significant(P﹤0.05),The Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,and Staphylococcus aureus were the predominant species of pathogens cultured from the lower respiratory tracts of the two groups of VAP patients.CONCLUSION The oral care with Yikou gargle can reduce the incidence of VAP in the patients undergoing MV.更多还原