双氧水联合碳酸氢钠口腔护理对预防新生儿呼吸机相关性肺炎的效果研究

The effects of oral care using hydrogen peroxide combined with sodium bicarbonate on neonatal ventilator associated pneumonia

目的探讨联合使用双氧水和碳酸氢钠进行口腔护理对预防新生儿呼吸机相关性肺炎的效果。方法用随机数字法将209例使用经口气管插管有创机械通气的新生儿分为实验组104例和对照组105例。两组在预防呼吸机相关性肺炎的常规机械通气护理措施基础上,实验组使用1.5%的双氧水联合2.5%的碳酸氢钠溶液进行口腔护理,对照组采用2.5%的碳酸氢钠溶液进行口腔护理,均为每8 h 1次,比较两组气管内痰培养阳性病原菌检测结果、呼吸机相关性肺炎的发生率、机械通气时间、住院时间及住院费用情况。结果机械通气48 h后,实验组痰培养病原菌阳性率低于对照组,差异具有统计学意义(P<0.05)。两组呼吸机相关性肺炎发生率,在机械通气48 h后,实验组低于对照组,差异具有统计学意义(P<0.05)。实验组机械通气时间及住院时间短于对照组,差异有统计学意义(P<0.05)。结论联合使用双氧水和碳酸氢钠进行口腔护理能有效清除新生儿口腔定植菌,预防新生儿呼吸机相关性肺炎,从而缩短患儿机械通气时间及住院时间。

Objective To investigate the effects of oral care using hydrogen peroxide and sodium bicarbonate to prevent neonatal ventilator associated pneumonia（VAP）. Methods Totally 209 neonates were recruited and divided into the experimental group with 104 cases and the control group with 105 cases by using random number table method. Based on conventional mechanical ventilation nursing,the experimental group received oral care using 1.5% hydrogen peroxide combined with 2.5% sodium bicarbonate,Q8H,while the control group received oral care using only 2.5% sodium bicarbonate,Q8H. Positive results of bacteria detection in tracheal sputum culture,the incidence rate of VAP,mechanical ventilation time,hospitalization time and hospitalization costs were compared between two groups. Results After 48 hours of mechanical ventilation,the difference in positive results of bacteria detection in tracheal sputum culture between two groups was statistically significant（P〈0.05）. The difference of incidence rate of VAP between two groups showed no statistical significance（P〉0.05） when the duration of the mechanical ventilation was 48 hours. While after 48 hours of the mechanical ventilation,the difference of the incidence rate of VAP between two groups was statistically significant（P〈0.05）. The differences in mechanical ventilation time and hospitalization time between two groups were statistically significant（P〈0.05）. The hospitalization costs of the experimental group was higher than that of the control group,while the difference showed no statistical significance（P〉0.05）. Conclusion The combined usage of hydrogen peroxide and sodium bicarbonate for oral care can effectively eliminate neonatal oral bacteria colonization and prevent neonatal VAP,so as to reduce the time of mechanical ventilation and hospitaliza- tion, and decrease hospitalization costs.