西吡氯铵含漱液口腔护理在预防呼吸机相关性肺炎的临床研究

Clinical study on the oral care by cetylpyridinium chloride in the prevention of ventilator-associated pneumonia

目的探讨西吡氯铵含漱液口腔护理对预防呼吸机相关性肺炎(VAP)的效果。方法选择2017年6月～2018年4月在我院行呼吸机治疗的患者60例为研究对象,随机分为三组:A组(西吡氯铵组)、B组(氯己定组)和C组(生理盐水组),每组20例。A组采用西吡氯铵含漱液口腔护理,B组采用复方氯己定口腔护理,C组采用生理盐水口腔护理。比较患者VAP发生情况及护理效果。结果三组口腔护理后,随着插管后4 h时间的延长,咽拭子菌落培养水平均呈上升趋势(P<0.05);插管后4 h、6 h、8 h,B组、C组咽拭子菌落水平显著高于A组,C组显著高于B组,差异均有统计学意义(P<0.05)。C组VAP发生率最高,其次为B组,C组显著高于A组(P<0.05);B组与A组比较差异无统计学意义(P>0.05)。B组与C组MV时间、ICU住院时间显著长于A组,C组显著长于B组,差异有统计学意义(P<0.05);三组死亡率比较差异无统计学意义(P>0.05)。1周后,A组与B组口腔清洁评分显著低于入住ICU时,差异有统计学意义(P<0.05);入住ICU后1周,C组口腔清洁评分最高,显著高于B组与A组,B组高于A组,差异均有统计学意义(P<0.05)。结论西吡氯铵含漱液口腔护理能够有效预防呼吸机相关性肺炎。

Objective To investigate the effect of oral care by cetylpyridinium chloride in the prevention of ventilatorassociated pneumonia. Methods 60 patients who were given ventilator for treatment in our hospital from June 2017 to April 2018 were selected as the study subjects, and were randomly divided into three groups: group A(cetylpyridinium chloride group), group B(chlorhexidine group) and group C(normal saline group), with 20 cases in each group. Group A was given oral care by cetylpyridinium chloride gargle, group B was given oral care by compound chlorhexidine, and group C was given oral care by normal saline. The occurrence of VAP and the effect of nursing care were compared between the patients. Results After the oral care in the three groups, the colony culture level of throat swabs was in an increasing trend with the prolongation of intubation time 4 h(P<0.05);at 4 h, 6 h and 8 h after intubation, the colony level of throat swabs in group B and group C was significantly higher than that in group A, and group C was significantly higher than group B. The differences were statistically significant(P<0.05). The incidence rate of VAP was the highest in group C, followed by group B, and group C was significantly higher than group A(P<0.05);there was no statistically significant difference between group B and group A(P>0.05). The MV time and length of ICU stay in group B and group C were significantly longer than those in group A, and group C was significantly longer than group B. The differences were statistically significant(P<0.05);there was no statistically significant difference in the mortality rate among the three groups(P>0.05). After 1 week, the oral cleansing scores in group A and group B were significantly lower than those upon admission to the ICU, and the difference was statistically significant(P<0.05);one week after ICU admission, the oral cleansing score in group C was the highest, which was significantly higher than that in group B and group A, and group B was higher than group A. The differences were statistically significant(P<0.05). Conclusion Oral care by cetylpyridinium chloride gargle can effectively prevent ventilator-associated pneumonia.