中药制剂对口咽部细菌去定植及防治呼吸机相关性肺炎的临床观察

Clinical Observation of Chinese Medicinal Preparation for Removal of Bacterial Colonization in Oropharynx and Prevention of Ventilator-associated Pneumonia

目的:研究中药制剂对重症患者口咽部细菌去定植、呼吸机相关性肺炎(VAP)发病率及其致病菌的影响。方法:选取2019年3月至2020年9月青岛大学附属医院重症监护病房(ICU)采用机械通气的患者共140例作为研究对象,在常规护理的基础上,根据使用口腔洗漱液的不同分为复方氯己定组和中药制剂组,每组70例。复方氯己定组采用复方氯己定含漱液,中药制剂组采用中药制剂。2组均每6 h间断采用不同漱液清洁患者口咽部及声门下滞留物,再通过吸引管吸除。比较2组患者声门下滞留物的细菌学检查、机械通气时长、ICU住院时长、VAP发病率、28 d死亡率、致病菌种类及其分布情况。结果:中药制剂组机械通气后声门下滞留物菌落数明显少于复方氯己定组(P<0.05),对革兰氏阴性致病菌引起的VAP占明显优势(P<0.05);中药制剂组持续机械通气总时长低于复方氯己定组(P<0.05);2组患者VAP发病率、ICU住院时长、28 d死亡率差异无统计学意义(P>0.05)。结论:与复方氯己定含漱液比较,中药制剂可有效去除口咽部及声门下细菌定植,有降低VAP发病率的可能,同时具备安全、有效、舒适度高等优点,有较高的临床应用和推广价值。

Objective:To study the effects of Chinese medicinal preparation on the removal of bacterial colonization in oropharynx and the incidence and pathogen of ventilator-associated pneumonia(VAP)in critically ill patients.Methods:A total of 140 patients who received mechanical ventilation in the Intensive Care Unit(ICU)of the Affiliated Hospital of Qingdao University from March 2019 to September 2020 were selected and randomized into a control group(n=70)and an observation group(n=70).Both groups received routine treatment.In addition,the control group was treated with compound chlorhexidine gargle and the observation group B with Chinese medicinal preparation.Different gargles were used to clean the oropharynx and subglottic retention every 6 h and then removed by a suction tube.The bacteriological characteristics,duration of mechanical ventilation,length of ICU stay,VAP incidence,28-day mortality rate,and species and distribution pathogenic bacteria in the subglottic retention were compared between the two groups.Results:The observation group had fewer colonies in the subglottic retention after mechanical ventilation than the control group(P<0.05),demonstrating the potential of inhibiting the VAP caused by Gram-negative bacteria(P<0.05).The total duration of mechanical ventilation in the observation group was shorter than that in the control group(P<0.05).The incidence of VAP,length of ICU stay,and 28-day mortality rate showed no significant differences between the two groups(P>0.05).Conclusion:Compared with compound chlorhexidine gargle,the Chinese medicinal preparation can effectively remove bacterial colonization in the oropharynx and subpharynx and has the potential to reduce the incidence of VAP,being safe,effective,and highly comfortable.Therefore,it has a high clinical application and promotion value.