选择性口咽去污染防治呼吸机相关性肺炎的临床观察

Effect of selective oral decontamination on preventing ventilatorassociated pneumonia

摘要:

目的观察口咽去污染对降低机械通气患者呼吸机相关性肺炎（VAP）发病率的意义。方法选择某院2012年1—6月入住重症监护室(ICU)内72 h以上且机械通气时间超过48 h的患者60例，随机分为实验组和对照组各30例。所有入选病例均给予静脉滴注头孢噻肟4 d，实验组机械通气全程用妥布霉素局部滴入口咽部，对照组用生理盐水局部滴入，记录两组患者发生VAP的病例数、发病时间及机械通气时间、ICU住院时间、病死率。定期留取气管内痰液进行细菌培养。结果实验组VAP的发病率为30.00%，明显低于对照组的63.33%； VAP的发病时间为(9.37±6.62)d，迟于对照组的(5.17±4.72)d；总机械通气时间为(7.63±6.91)d，低于对照组的(12.26±9.36)d；住ICU时间为(13.56±7.22)d，低于对照组的(16.79±11.16)d；上述项两组比较，均P<0.05。两组病死率比较，差异无统计学意义(P＞0.05)。结论口咽去污染是防治VAP的有效方法，能有效降低VAP发生率，使VAP发病时间延迟，并减少机械通气时间及入住ICU时间。

关键词:

选择性口咽去污染; 呼吸机相关性肺炎; 妥布霉素; 医院感染

Abstract:

ObjectiveTo evaluate the effect of selective oral decontamination (SOD) on reducing incidence of ventilatorassociated pneumonia (VAP).MethodsSixty patients hospitalized in an intensive care unit (ICU)for >72 hours and with mechanical ventilation for >48 hours from January to June 2102 were selected for study,patients were randomly divided into trial group(n=30) and control group(n=30).All patients received cefotaxime intravenous drip for 4 days, then trial group received oropharyngeal application of tobramycin during the whole process of mechanical ventilation, control group topically received saline solution, the incidence and onset time of VAP, duration of mechanical ventilation, length of stay in ICU, and mortality of two groups were compared. Sputum in the trachea was taken periodically for bacterial culture.ResultsThe incidence of VAP in trial group was lower than control group (30.00% vs 63.33%)；the onset time of VAP was later than control group (［9.37±6.62］d vs ［5.17±4.72］d)；Overall duration of mechanical ventilation was less than control group (［7.63±6.91］d vs ［12.26±9.36］d)；length of stay in ICU was shorter than control group(［13.56±7.22］d vs ［16.79±11.16］d)(all P<0.05). There were no significant difference in mortality between two groups(P>0.05).ConclusionSOD is effective for preventing and treating VAP,it can reduce the incidence of VAP, delay onset time of VAP, shorten mechanical ventilation,and reduce length of stay in ICU.

Key words:

selective oral decontamination; ventilatorassociated pneumonia; tobramycin;healthcareassociated infection