选择性口咽部脱污染技术对机械通气患者预防呼吸机相关肺炎的影响

Selective Oropharyngeal Decontamination in Critically Ill Patients

摘要: 目的：探讨在口腔护理中应用选择性口咽部脱污染技术对机械通气患者预防呼吸机相关肺炎的影响。方法：选择2017年1月至2018年12月江苏大学附属武进医院重症监护病房预计需实施机械通气治疗72小时以上的患者，随机分为实验组和对照组。对照组采用常规口腔护理，实验组在常规口腔护理基础上应用选择性口咽部脱污染技术，比较两组患者咽拭子及下呼吸道分泌物培养阳性率、呼吸机相关性肺炎及死亡的发生率。结果：实验组患者咽拭子及下呼吸道分泌物培养阳性率及呼吸机相关性肺炎发生率均低于对照组(均P < 0.05)。结论：在常规口腔护理基础上应用选择性口咽部脱污染技术，可以有效清除部分口咽部定植菌，降低呼吸机相关性肺炎发生率，值得临床推广应用。

Abstract: Objective: To explore the effect of selective oropharyngeal decontamination in oral care on pre-vention of ventilator-associated pneumonia in mechanically ventilated patients. Methods: Patients who were scheduled to undergo mechanical ventilation for more than 72 hours in the intensive care unit of Wujin Hospital affiliated to Jiangsu University from January 2017 to December 2018 were randomly divided into experimental group and control group. The control group used conventional oral care. The experimental group applied selective oropharyngeal decontamination technology on the basis of routine oral care. The positive rate of throat swab and lower respiratory secretion culture, and the incidence of ventilator-associated pneumonia and death occurring in the two groups were compared. Results: The positive rate of throat swab and lower respiratory secretion culture and the incidence of ventilator-associated pneumonia in the experimental group were lower than those in the control group (both P < 0.05). Conclusion: The application of selective oropharyngeal decontamination technology on the basis of conventional oral care can effectively remove some oropharyngeal colonization bacteria and reduce the incidence of ventilator-associated pneumonia, which is worthy of clinical application.