本文關鍵詞： 洗必泰 阿米卡星 重癥監(jiān)護病房 呼吸機相關性肺炎　出處：《重慶醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的：探討應用洗必泰擦浴聯(lián)合阿米卡星滴鼻在預防重癥監(jiān)護病房（IntensiveCareUnit,ICU）呼吸機相關性肺炎（VentilatorAssociatedPneumonia，VAP）中的作用。 方法：將2010年10月至2011年12月進行有創(chuàng)機械通氣治療的162例患者按照1:1:1比例隨機分為3組：清水擦浴組（54例），單純清水全身擦浴，每日兩次至轉出ICU；洗必泰擦浴組（54例），單純2%洗必泰全身擦浴，每日兩次至轉出ICU；聯(lián)合處理組（54例），給予2%洗必泰全身擦浴，每日兩次至轉出ICU，，聯(lián)合0.02g/次阿米卡星滴鼻,每日3次，連續(xù)滴鼻1周后停用。三組均使用5%碳酸氫鈉溶液口腔護理（2次/日），觀察3組經(jīng)上述處理后各自的VAP發(fā)生率以及致病菌耐藥情況變化。同時觀察應用洗必泰擦浴后臨床不良事件發(fā)生情況。 結果：清水擦浴組VAP發(fā)生率為48.1%(26/54),洗必泰擦浴組VAP發(fā)生率為25.9%（14/54），聯(lián)合處理組VAP發(fā)生率22.2%（12/54），洗必泰擦浴組和聯(lián)合處理組VAP發(fā)生率明顯低于清水擦浴組（P0.05），而洗必泰擦浴組和聯(lián)合處理組兩組間VAP發(fā)生率無明顯差異（P0.05）。對于ICU常見耐藥菌多重耐藥鮑曼不動桿菌（MDRAB）和耐甲氧西林金黃色葡萄球菌（MRSA）的感染率，洗必泰擦浴組和聯(lián)合處理組較清水擦浴組明顯減低（P0.05）。分析VAP致病菌耐藥情況變化，我們選取ICU最常見VAP致病菌7種（銅綠假單胞菌、鮑曼不動桿菌、肺炎克雷伯氏菌、大腸埃希菌、嗜麥芽假單胞菌、金黃色葡萄球菌、腸球菌），比較清水擦浴組、洗必泰擦浴組和聯(lián)合處理組分離出的同種致病菌耐藥情況，結果提示三組分離出的致病菌耐藥率無明顯差異（P0.05）。108例采用洗必泰擦浴患者僅2例出現(xiàn)接觸性皮炎（1.85%），未發(fā)生過敏性休克，醫(yī)護人員接觸后未發(fā)生哮喘和呼吸困難。 結論：應用洗必泰全身擦浴可安全有效預防ICU呼吸機相關性肺炎發(fā)生，特別是降低了MDRAB、MRSA的感染率，未引起細菌耐藥率的升高；洗必泰擦浴聯(lián)合阿米卡星滴鼻較單純洗必泰擦浴在預防ICU呼吸機相關性肺炎上未見顯著優(yōu)勢，短期應用阿米卡星滴鼻雖未引起細菌耐藥率的升高，但隨著時間推移局部應用抗生素往往是引起致病菌耐藥性升高的高危因素之一，為防止細菌耐藥率的升高，不推薦長期應用阿米卡星滴鼻用于ICU預防VAP的發(fā)生。
[Abstract]:Objective: to investigate the role of chlorhexidine in combination with amikacin nasal drops in the prevention of ventilator associated pneumonia (VAPs) in intensive care unit (ICU). Methods: a total of 162 patients undergoing invasive mechanical ventilation from October 2010 to December 2011 were randomly divided into 3 groups according to the ratio of 1: 1: 1: 1: 1: 54 cases in the clean water bath group and 54 cases in the clean water group. Two times a day to transfer out of ICU; chlorhexidine bath group 54 cases, only 2% whole body bath, 2 times a day to transfer to ICU; combined treatment group of 54 cases, given 2% chlorhexidine whole body bath, twice a day to transfer out of ICU, combined with 0.02 g / time Amikacin nasal drops, Three times a day, The oral nursing care of 5% sodium bicarbonate solution was used twice a day in the three groups. The incidence of VAP and the drug resistance of pathogenic bacteria were observed in the three groups after the above treatment. At the same time, the changes of drug resistance of chlorhexidine were observed. Clinical adverse events after bath. Results: the incidence of VAP in the clean water bath group was 48.1% and that in the chlorhexidine bath group was 25.914 / 54. The incidence of VAP in the combined treatment group was 22.2g / 54.The incidence of VAP in the chlorhexidine bath group and the combined treatment group was significantly lower than that in the clean water bath group (P 0.05), while the incidence rate in the chlorhexidine group was significantly lower than that in the clean water bath group (P 0.05). There was no significant difference in the incidence of VAP between the two groups compared with the combined treatment group (P 0.05). The infection rate of Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (ICU) was detected. After analyzing the changes of drug resistance of VAP pathogens, we selected the most common VAP pathogens of ICU (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae). Escherichia coli, Pseudomonas maltophilia, Staphylococcus aureus, Enterococcus spp., were compared with the drug resistance of the control group, the chlorhexidine group and the combined treatment group. The results showed that there was no significant difference in drug resistance rate of pathogenic bacteria isolated from the three groups. Only 2 patients with contact dermatitis and no anaphylactic shock were found in 108 patients treated with chlorhexidine. No asthma or dyspnea was found in medical staff after contact. Conclusion: it is safe and effective to use chlorhexidine in the whole body to prevent ICU ventilator-associated pneumonia, especially to reduce the infection rate of MRSA, but not to increase the rate of bacterial resistance. There was no significant advantage in preventing ICU ventilator-associated pneumonia by taking chlorhexidine in combination with amikacin nasal drops. Although the short-term application of amikacin did not cause the increase of bacterial drug resistance rate, there was no significant difference in the prevention of ICU ventilator-associated pneumonia. However, local use of antibiotics is often one of the high risk factors for the increase of drug resistance of pathogenic bacteria. In order to prevent the increase of bacterial drug resistance rate, it is not recommended to use amikacin nasal drops for long-term ICU to prevent the occurrence of VAP.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.1

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