复方利多卡因乳膏涂覆气管导管干预呼吸机相关肺炎的动物实验研究

Experimental Study on Prevention Ventilator-associated Pneumonia by Compound Lidocain Cream

目的观察复方利多卡因乳膏涂覆气管导管后对呼吸机相关肺炎(ventilator associated pneumonia,VAP)发病的影响,旨在探索预防VAP的新途径。方法选取健康雄性成年新西兰白兔48只,随机分为4组,即空白对照组、模型对照组、干预对照组和干预观察组,每组12只。空白对照组气管导管不做任何处理,插管后不接种铜绿假单胞菌(PA);模型对照组气管导管不做任何处理,插管后2 h接种5.0×108cfu/ml的PA。干预对照组气管导管前端10 cm部分涂覆石蜡油,干预观察组气管导管前端10 cm部分涂覆复方利多卡因乳膏,两干预组均于插管后2 h接种5.0×108cfu/ml的PA。于建模后72 h处死白兔,解剖并留取肺组织病理标本,同时留取支气管肺泡灌洗液(BALF)和颈内静脉血行细菌培养。结果空白对照组未发生明显肺组织炎症改变;模型对照组、干预对照组和干预观察组VAP发病率分别为100%、90.91%和33.33%,组间比较差异有明显统计学意义(P<0.01)。接种PA的3组血培养阳性率比较差异无统计学意义(P>0.05);模型对照组和干预对照组的BALF细菌培养阳性率(100%和90.91%)明显高于干预观察组(58.33%),差异有统计学意义(P<0.05)。结论复方利多卡因乳膏涂覆气管导管可以有效减轻VAP的发生。

Objective To investigate the influence of compound lidocain cream on ventitator-assoeiated pneumonia（VAP） after tracheal intubation, and to find a new way to prevent the VAP. Methods 48 rabbits were randomly divided into four groups： control group, model group, model preventive group I and model preventive group Ⅱ. The tracheal tubes were smeared with nothing in control group and model group and with liquid paraffin in model preventive group I and with compound lidoeain cream in model preventive group Ⅱ. After 2 hours of mechanical ventilation, animals in model group, model preventive group I and model preventive group Ⅱ were infected intrabronchially with a calibrated inoeulum, and the inoculum was pseudomonas aeruginosa （PA） of 5.0 × l0s efu/ml, while animals in control group was adopted with the same dose of saline solution. The animals were killed 72 h after inoculation. The lungs were for pathologic check, the blood of jugular vein and bronehoalveolar lavage fluid（BALF） was for bacterial culture. Results Rabbits in control group were not infected with PA. Lung of 100% of rabbits in model group, lung of 90.91% of rabbits in model preventive group I and lung of 33.33% of rabbits in model preventive group Ⅱ showed pathological changes. The positive rate of BALF was 100% , 90. 91% and 58.33% respectively in model group, model preventive group I and mode/preventive group Ⅱ, but the positive rate of blood was not obviously different in above three groups. Conclusion The data proposes that tracheal tube was smeared with compound lidocain cream may prevent the ventitator-associated pneumonia after mechanical ventilation.