清热解毒汤剂湿化干预预防ICU呼吸机相关肺炎发生的临床实践

Clinical practice of humidification intervention of Qingre Jiedu Decoction in preventing ventilator-associated pneumonia in ICU patients

目的探讨清热解毒汤剂湿化干预预防ICU呼吸机相关肺炎(VAP)发生的临床效果。方法选取2022年1月到2023年1月在本院进行治疗的98例ICU机械通气患者,按照随机数表法分为观察组与对照组(各49例)。对照组给予氯己定常规口腔湿化护理干预,观察组在对照组基础上给予清热解毒汤剂口腔湿化护理干预。比较2组患者VAP的发生情况、住院情况、口腔分泌物致病菌检出情况及干预前后的口腔不良情况及血气分析指标、炎性指标水平。结果观察组共发生1例(2.04%)VAP,对照组共发生8例(16.33%)VAP,观察组VAP发生率低于对照组(χ^(2)=5.995,P=0.014);干预后,2组患者牙龈肿胀、口腔异味发生率均比干预前低,且观察组牙龈肿胀、口腔异味均低于对照组(P<0.05);观察组住院时间、ICU时间及机械通气时间均短于对照组(P<0.05);观察组真菌孢子菌丝、革兰氏阳性菌、革兰氏阴性菌检出率低于对照组,口腔正常菌群检出率高于对照组(P<0.05);干预后,两组患者氧饱和度(SaO_(2))、氧分压(PaO_(2))水平均比干预前升高,二氧化碳分压(PaCO_(2))水平均比干预前降低,且观察组SaO_(2)、PaO_(2)水平高于对照组,PaCO_(2)水平低于对照组(P<0.05);干预后,2组患者白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)水平均低于干预前,且观察组WBC、CRP、PCT水平均低于对照组(P<0.05)。结论清热解毒汤剂口腔湿化干预可有效预防ICU患者VAP的发生,改善患者血气指标及口腔不良情况,减少致病菌的种植,缩短治疗时间,更利于患者康复。

Objective To investigate the clinical effect of humidification intervention of Qingre Jiedu Decoction in the prevention of ventilator-associated pneumonia(VAP)in intensive care unit(ICU)patients.Methods Ninety-eight patients with mechanical ventilation in ICU of our hospital from January 2022 to January 2023 were enrolled,and they were divided into observation group(n=49)and control group(n=49)according to a random number table.All patients were given routine humidification nursing(chlorhexidine),and those in the observation group were additionally given humidification nursing of Qingre Jiedu Decoction.The occurrence of VAP,hospitalization,and detection rate of pathogenic bacteria in oral secretions were compared before and after intervention between groups.The oral adverse events,blood gas analysis indexes,and inflammatory indexes were assessed.Results The incidence of VAP in the observation group was significantly lower than that in the control group(2.04%[1/49]vs 16.33%[8/49],χ^(2)=5.995,P=0.014).After intervention,the incidence of gum swelling and bad breath in both groups was lower than before intervention,and which in the observation group was more pronounced compared to the control group(P<0.05).The length of hospital stay,ICU time and mechanical ventilation time in observation group were significantly shorter than those of control group(P<0.05).The detection rates of fungal spore mycelium,Gram-positive and Gram-negative pathogenic bacteria in observation group were significantly lower than those of the control group,but the detection rate of oral normal bacteria was significantly higher(P<0.05).After intervention,the levels of arterial oxygen saturation(SaO_(2))and partial pressure of oxygen(PaO_(2))in the both groups were significantly higher than before intervention,whereas the level of arterial carbon dioxide tension(PaCO_(2))was significantly lower than before intervention,the observation group was superior to the control group for the level of SaO_(2),PaO_(2) and PaCO_(2)(P<0.05).After intervention,the levels of white blood cell(WBC),C-reactive protein(CRP),and procalcitonin(PCT)in the both groups were lower than before intervention,and the decrease in observation group was more common compared to the control group(P<0.05).Conclusion The humidification intervention of Qingre Jiedu Decoction can effectively prevent the occurrence of VAP in ICU patients,improve the blood gas index,decrease oral adverse events,reduce the planting of pathogenic bacteria,shorten the treatment time,and it is more conducive to the recovery of patients.