口腔护理联合气流冲击法对气管插管机械通气患者呼吸机相关性肺炎的影响

目的 探讨口腔护理联合气流冲击法对经口气管插管机械通气患者预防呼吸机相关性肺炎(VAP)的干预效果.方法 选取2016年6月至2017年7月安徽省立医院ICU收治的96例经口气管插管患者,采用随机数字表法将患者分为对照组和试验组,每组48例.对照组予0.12％洗必泰溶液配合可冲洗式牙刷刷洗进行口腔护理,试验组先用气流冲击法清除气囊上滞留物,再采用同对照组相同的口腔护理方法进行操作,比较两组患者VAP的发生率、机械通气时间以及ICU住院时长.结果 方案数据分析(PP)显示试验组与对照组VAP的发生率分别为4.35％、18.28％,意向性分析(ITT)显示两组VAP的发生率分别为8.33％、25.00％,不同分析结果得出两组的VAP发生率差异均具有统计学意义(P<0.05);方案数据分析(PP)显示试验组患者机械通气时间、ICU住院时长分别为(7.41±2.86)d、(11.24±3.18)d,对照组患者机械通气时间、ICU住院时长分别为(9.98±3.45)d、(12.96±4.01)d,两组比较差异具有统计学意义(P<0.05).结论 经口气管插管患者进行口腔护理前联合气流冲击法能够降低VAP的发生率,间接减少机械通气时间与ICU入住时长.

Effect of oral carecombined with air-impact method on ventilator-associated pneumonia in patients with mechanical ventilation via tracheal tubing

Objective To investigate the preventive effect of oral care practice combined with air-impact method on ventilator-as-sociated pneumonia ( VAP) in those patients with orotracheally intubated mechanical ventilation. Methods Ninety-six patients ever trea-ted with orotracheal intubation in our hospital between Jun 2016 and Jul 2017 were chosen and divided into two groups by means of random number table. Patients in the control (48 cases) and study (48 cases) groups were both given oral care of oral cavity brushing with 0. 12％chlorhexidine solution and rinsable toothbrush. But patients in the study group first had their subglottic secretion cleaned up by air-impact method before oral care practice. Then, the incidence rate of VAP, time of mechanical ventilation and hospital stays in ICU between the two groups were recorded and compared. Results Per -protocol ( PP) analysis showed that the incidence of VAP in the study and control groups were 4. 35％ and 18. 28％, respectively, whereas intention-to-treat (ITT) analysis showed that the incidence of VAP in them were 8. 33％ and 25. 00％, respectively. From results of different analysis, there both had statistically significant differences in the incidence of VAP between the two groups (P<0. 05). Furthermore, PP analysis indicated that the mechanical ventilation time and ICU hospital stays were (7. 41 ± 2. 86) d and (11. 24 ± 3. 18) d in the study group, (9. 98 ± 3. 45) d and (12. 96 ± 4. 01) d in the control group, respective-ly, and there were significant differences between them (all P<0. 05). Conclusion Before oral care practice for patients with orotracheal intubation, introduction of air-impact method to clean up subglottic secretion could reduce the incidence of VAP, and further indirectly shorten the mechanical ventilation time and ICU hospital stays.