激励式呼吸训练联合口腔去污染对老年胃癌患者手术后肺炎的影响

目的 探讨激励式呼吸训练联合口腔去污染对老年胃癌患者手术后肺炎（POP）的影响。方法 前瞻性收集2019年1月—2020年6月在福建中医药大学附属第二人民医院行胃癌根治术老年患者，随机分成试验组和对照组。对照组行围手术期常规护理，试验组在此基础上采用激励式肺计量器训练联合洗必泰口腔去污染。分析两组POP发病率、口咽部定植菌检出率等指标。结果 共纳入96例老年胃癌手术患者，试验组和对照组各48例。13例患者发生POP，POP发病率为13.54%。试验组患者POP发病率为6.25%，低于对照组的20.83%，差异有统计学意义（P<0.05）。干预后试验组患者口咽部定植菌检出率（6.25%）低于对照组（20.83%），差异有统计学意义（P<0.05）；干预后试验组患者6 min步行距离及呼吸训练依从性均高于对照组，差异有统计学意义（均P<0.05）；试验组术中机械通气时间、术后住院日数、抗菌药物费用、总住院费用均低于对照组，差异有统计学意义（均P<0.05）。结论 老年胃癌患者围手术期进行激励式呼吸训练和口腔去污染有助于改善运动耐量，减少呼吸道微生物定植，降低POP发病率，促进患者康复。

Effect of incentive breathing training combined with oral decontamination on postoperative pneumonia in elderly patients with gastric cancer

Objective To explore the effect of incentive breathing training combined with oral decontamination on postoperative pneumonia (POP) in elderly patients with gastric cancer. Methods Elderly patients undergoing radical gastrectomy for gastric cancer at the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine from January 2019 to June 2020 were prospectively collected and randomly divided into experimental group and control group. Control group received routine care during peri-operative period, experimental group used incentive spirometer training combined with chlorhexidine oral decontamination on the basis of routing care. Incidence of POP, oral and pharyngeal bacterial colonization and other indicators in two groups of patients were analyzed. Results A total of 96 elderly patients with gastric cancer were included, 48 cases in experimental group and 48 in control group. 13 patients (13.54%) had POP. Incidence of POP in patients in experimental group was 6.25%, which was lower than 20.83% in control group, with a significant difference (P<0.05). After intervention, isolation rate of oral-pharyngeal colonized bacteria in experimental group was lower than that in control group (6.25% vs 20.83%, P<0.05); after intervention, 6-minute walking test and compliance to respiratory training in patients in experimental group were both higher than control group (both P<0.05); duration of intra-operative mechanical ventilation, postoperative hospital stay, cost of antimicrobial agents and total hospitalization expenses in experimental group were all lower than those in control group (all P<0.05). Conclusion Peri-operative incentive breathing training and oral decontamination in elderly patients with gastric cancer can help to improve exercise tolerance, reduce respiratory tract microbial colonization, decrease incidence of POP, and promote recovery of patients.