【摘要】：目的探討口腔干預(yù)時(shí)機(jī)對(duì)重癥監(jiān)護(hù)病房氣管插管患者呼吸機(jī)相關(guān)肺部感染的影響。方法選取2012年5月-2016年12月醫(yī)院ICU收治的經(jīng)口氣管插管患者1 230例患者,隨機(jī)分為即刻組、4h組和8h組,每組410例;即刻組、4h組和8h組三組患者分別在插管后即刻、4h和8h介入首次口腔干預(yù),插管后、插管后6h和插管后12h分別對(duì)患者上頜前臼齒上的牙菌斑情況進(jìn)行評(píng)分,并統(tǒng)計(jì)各組呼吸機(jī)相關(guān)性肺炎(VAP)發(fā)生率、機(jī)械通氣時(shí)間和入住ICU時(shí)間,對(duì)發(fā)生VAP患者,采集患者痰液標(biāo)本進(jìn)行菌株鑒定。結(jié)果三組VAP發(fā)生率、機(jī)械通氣時(shí)間和入住ICU時(shí)間比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);4h組和8h組VAP發(fā)生率、機(jī)械通氣時(shí)間和入住ICU時(shí)間顯著高于即刻組(P0.05),且8h組高于4h組(P0.05);插管后即刻組牙菌斑評(píng)分為0.256±0.035;插管后6h,即刻組牙菌斑評(píng)分顯著低于4h組(P0.05),插管后12h,三組牙菌斑評(píng)分差異無統(tǒng)計(jì)學(xué)意義;53例VAP患者共檢出64株病原菌,其中革蘭陰性菌41株,占64.06%,革蘭陽性菌18株,占28.13%,真菌5株,占7.81%。結(jié)論重癥監(jiān)護(hù)病房氣管插管患者應(yīng)及時(shí)行口腔干預(yù)有效預(yù)防VAP的發(fā)生,降低患者入住ICU時(shí)間、機(jī)械通氣時(shí)間。
[Abstract]:Objective to investigate the effect of oral intervention on ventilator-associated pulmonary infection in patients with endotracheal intubation in intensive care unit (ICU). Methods from May 2012 to December 2016, 1 230 patients with oral endotracheal intubation were randomly divided into immediate group, 4 h group and 8 h group with 410 patients in each group. The patients in immediate group, 4 h group and 8 h group were intervened in the first oral intervention immediately, 4 h and 8 h after intubation, respectively. the dental plaque on maxillary premolar was scored 6 h after intubation and 12 h after intubation, and the incidence of (VAP), mechanical ventilation time and ICU stay time in each group were counted. The sputum samples of patients with VAP were identified. Results there were significant differences in the incidence of VAP, mechanical ventilation time and ICU stay time among the three groups (P 0.05). The incidence of VAP, mechanical ventilation time and ICU time in 4 h group and 8 h group were significantly higher than those in immediate group (P 0.05), and the dental plaque score in 8 h group was 0.256 鹵0.035%. At 6 h after intubation, the dental plaque score in the immediate group was significantly lower than that in the 4 h group (P 0.05), and there was no significant difference in the dental plaque score among the three groups at 12 h after intubation. A total of 64 strains of pathogenic bacteria were detected in 53 patients with VAP, including 41 strains of Gram-negative bacteria (64.06%), 18 strains of Gram-positive bacteria (28.13%) and 5 strains of fungi (7.81%). Conclusion Oral intervention should be carried out in intensive care unit (ICU) to prevent the occurrence of VAP and reduce the time of ICU and mechanical ventilation.
【作者單位】： 海南醫(yī)學(xué)院附屬第二醫(yī)院重癥醫(yī)學(xué)科;
【分類號(hào)】：R473.5

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