美洲大蠊提取物干预口腔定植菌对院内获得性肺炎发生的影响

Effect of periplaneta americana extract intervention of oral colonized bacteria on the incidence of hospital acquired pneumonia

目的观察具有罹患院内获得性肺炎（HAP）高危因素的住院患者经美洲大蠊提取物口腔干预后对HAP发生率和口腔定植菌的变化。方法采用前瞻性、非双盲、随机对照研究方法，选择2015年2月至8月浙江中医药大学附属温州中西医结合医院住院确诊为HAP的患者200例，在患者入组后即行口腔定植菌培养，而后按随机数字表法分为试验组（机械即刷牙＋大蠊提取物干预组）和对照组（机械干预组），每组100例，最终纳入试验组96例，对照组94例；经口腔干预2周后再次行口腔定植菌培养。观察两组口腔定植菌数、HAP发生率和病死率。结果试验组干预后口腔定植菌数较对照组明显减少（株：36比64，P〈0．05），试验组HAP发生率和病死率也较对照组明显减少[6．25％（6／96）比15．96％（15／94），2．08％（2／96）比6．38％（6／94），均P〈0．05]。结论美洲大蠊提取物具有独特的抗菌作用，干预口腔定植菌后，可以明显减少HAP的发生。

Objective To observe the change of the incidence of hospital acquired pneumonia （HAP） and colonized bacteria after hospitalized patients with high risk factors to acquire HAP experienced periplaneta americana extract oral intervention. Methods A prospective, no double-blind, randomized controlled study was conducted, 200 patients firmly diagnosed as HAP admitted to Integration of Traditional Chinese and Western Medicine Hospital of Wenzhou, Affiliated to Zhejiang University of Traditional Chinese Medicine from February to August 2015 were enrolled. After grouping of patients, oral colonized bacteria culture was carried out for them immediately, afterwards they were randomly divided into two groups： an experimental group （machinery brush of teeth ＋ periplaneta americana extract oral intervention） and a control group （machinery brush of teeth intervention）, 100 cases in each group. A total of 190 patients were included for the study of clinical efficacy evaluation, with 96 cases in experiment group, and 94 cases in control group. After oral intervention for 2 weeks, the oral colonized bacteria were cultured again. The number of oral bacteria colonization, HAP incidence and case fatality were observed in the two groups. Results The number of oral bacteria colonization in experiment group was significantly reduced compared with that of the control group （36 stain vs. 64 stain, P 〈 0.05）, and the incidence of HAP and case fatality in experimental group were also significantly lower than those in the control group [6.25% （6/96） vs. 15.96% （15/94）, 2.08% （2/96） vs. 6.38% （6/94）, both P 〈 0.05]. Conclusion Periplaneta americana extract has a unique antibacterial effect, after its intervention of oral colonized bacteria in patients with high risk to acquire HAP, the incidence of HAP can be significantly reduced.