口腔冲洗法在预防呼吸机相关性肺炎中的应用

Efficacy of mouth cavity irrigation in prevention of ventilator-associated pneumonia

目的探讨改良口腔冲洗法在预防呼吸机相关性肺炎(VAP)中的应用及效果,以便更好为人工气道行机械通气的患者提供护理。方法将60例行经口气管插管并给予机械通气治疗>48h患者随机分为观察组和对照组,各30例,对照组采用传统生理盐水棉球顺序擦洗法行口腔护理,观察组采用生理盐水冲洗法行口腔护理,从患者口腔细菌繁殖状况、口腔感染、并发症发生率等方面进行统计分析,并观察两组机械通气后VAP发生率以及机械通气持续时间。结果两组在进行口腔护理前细菌培养结果比较,观察组、对照组阳性例数均为26例,细菌种类均为4种,阳性例数和细菌种类差异无统计学意义;两组进行口腔护理后细菌培养结果比较,观察组阳性1例,细菌种类2种,对照组阳性4例,细菌种类4种,两组差异有统计学意义(P<0.01);两组在进行口腔护理后,对口腔清洁度、口腔真菌、口腔溃疡进行了比较,观察组明显优于对照组,差异均有统计学意义(P<0.05);两组在VAP发生率、呼吸机使用时间、病死率3个项目进行比较,观察组均明显优于对照组,VAP发生率观察组为16.67%、对照组为83.33%,两组差异有统计学意义(P<0.05),呼吸机使用时间观察组(7±3.6)d、对照组(13±5.4)d、两组差异有统计学意义(P<0.05),病死率观察组为3.33%、对照组为23.33%,两组差异有统计学意义(P<0.05)。结论利用冲洗法进行口腔护理的效果明显优于传统口腔护理法。

OBJECTIVE To study the effect of mouth cavity irrigation on prevention of ventilator-associatedpneumonia （VAP） so as to offer the patients undergoing airway mechanical ventilation the better nursing.METHODS Totally 60 patients who underwent orotracheal intubation and received the mechanical ventilation formore than 48 hours were divided into the observation group and the control group with 30 cases in each. Thecontrol group was treated with traditional cotton swab order saline solution method for the mouth care, while theobservation group was treated with the physiological saline irrigation line for the mouth care. The bacterialgrowth, oral infections, and incidence Qf complication of the two groups were statistically analyzed, and theincidence of VAP after the mechanical ventilation and the duration of mechanical ventilation were observed.RESULTS As compared the bacterial culture result before the oral care,there were 26 positive cases in both of thetwo groups with four species of bacteria, the difference in the number of positive cases or the species of bacteriabetween the two groups was not significantly. After the oral care,the result of bacterial culture showed that therewas 1 case positive in the observation group with 2 species of bacteria and 4 cases positive in the control group with4 species of bacteria, the difference was significant （P〈0. 01）. The observation group was significantly superiorto the control group after the oral care in the cleaningness of oral cavity, oral fungi,and oral ulcers,the differencewas significant （P〈0. 05）. The observation group was significantly superior to the control group in the incidence ofVAP,duration of use of ventilator,and the mortality〉 the incidence rate of VAP was 16. 67 % of the observation group,lower than 83. 33% of the control group, the duration of use of ventilator was （7±3. 6）days of the observation group,shorter than （13±5. 4）days of the control group, and the mortality of the observation group was 3. 33%,lower than23. 33% of the control group, the difference was significant（P〈0. 05）. CONCLUSION The mouth cavity irrigation issignificantly superior to the traditional oral care method in the oral care effect.