口腔干预时机对重症监护病房气管插管患者呼吸机相关肺炎的影响

Influence of time of oral intervention on ventilator-associated pulmonary in endoinfection tracheal intubation patients of intensive care unit

目的探讨口腔干预时机对重症监护病房气管插管患者呼吸机相关肺部感染的影响。方法选取2012年5月-2016年12月医院ICU收治的经口气管插管患者1 230例患者,随机分为即刻组、4h组和8h组,每组410例;即刻组、4h组和8h组三组患者分别在插管后即刻、4h和8h介入首次口腔干预,插管后、插管后6h和插管后12h分别对患者上颌前臼齿上的牙菌斑情况进行评分,并统计各组呼吸机相关性肺炎(VAP)发生率、机械通气时间和入住ICU时间,对发生VAP患者,采集患者痰液标本进行菌株鉴定。结果三组VAP发生率、机械通气时间和入住ICU时间比较差异均有统计学意义(P<0.05);4h组和8h组VAP发生率、机械通气时间和入住ICU时间显著高于即刻组(P<0.05),且8h组高于4h组(P<0.05);插管后即刻组牙菌斑评分为0.256±0.035;插管后6h,即刻组牙菌斑评分显著低于4h组(P<0.05),插管后12h,三组牙菌斑评分差异无统计学意义;53例VAP患者共检出64株病原菌,其中革兰阴性菌41株,占64.06%,革兰阳性菌18株,占28.13%,真菌5株,占7.81%。结论重症监护病房气管插管患者应及时行口腔干预有效预防VAP的发生,降低患者入住ICU时间、机械通气时间。

OBJECTIVE To explore the influence of timing of oral intervention on ventilator-associated pulmonary infection in endotracheal intubation patients of intensive care unit（ICU）.METHODS A total of 1 230 patients who were treated with oral tracheal intonation in ICU from May 2012 to Dec 2016 were enrolled in the study and randomly divided into the instant group,4-hour group,and 8-hour group,with 410 cases in each group.The instant group was given the first oral intervention immediately after the intubation,the 4-hour group was given the first oral intervention 4 hours after the intonation,and the 8-hour group was given the first oral intervention 8 hours after the intubation.The scoring of dental plaques on maxillary premolars was carried out after the intonation,after the intonation for 6 hours,and after the intubation for 12 hours;the incidence of ventilator-associated pneumonia（VAP）,mechanical ventilation duration and length of ICU stay were statistically analysed,the sputum specimens that were obtained from the patients with VAP were cultured,and the isolated pathogens were identified.RESULTS There was significant difference in the incidence of VAP,mechanical ventilation duration,or length of ICU stay among the three groups（P〈0.05）;the incidence of VAP was significantly higher in the 4-hour group and the 8-hour group than in the instant group,and the mechanical ventilation duration and length of ICU stay were significantly longer in the 4-hour group and the 8-hour group than in the instant group（P〈0.05）,which were significantly higher or longer in the 8-hour group than in the 4-hour group（P〈0.05）.The score of dental plaques of the instant group was 0.256±0.035 after the intubation;the score of dental plaques of the instant group was significantly lower than that of the 4-hour group after the intubation for 6 hours（P〈0.05）;there was no significant difference in the score of dental plaques among the three groups after the intubation for 12 hours.Totally 64 strains of pathogens were isolated from the 53 patients with VAP,of which 64.06%（41 strains）were gram-negative bacteria,28.13%（18 strains）were gram-positive bacteria,and 7.81%（5 strains）were fungi.CONCLUSION It is an effective way to conduct the oral intervention for the endotracheal intubation patients of ICU in a timely manner so as to prevent the VAP and shorten the length of ICU stay as well as the mechanical ventilation duration.