本文選題：復(fù)方氯己定　切入點(diǎn)：院內(nèi)獲得性肺炎　出處：《首都醫(yī)科大學(xué)》2013年碩士論文

【摘要】：【目的】研究不同口腔干預(yù)措施對(duì)長(zhǎng)期住院患者口腔呼吸道需氧致病細(xì)菌定植率及醫(yī)院內(nèi)獲得性肺炎（HAP）發(fā)病率的影響；從基因水平研究口腔內(nèi)需氧致病定植細(xì)菌與HAP病原菌的同源性。 【方法】將我院62名老年患者（65歲）隨機(jī)分為試驗(yàn)組（n=31）和對(duì)照組（n=31），試驗(yàn)組每日兩次予復(fù)方氯己定清潔口腔,對(duì)照組每日兩次予生理鹽水清潔口腔，研究對(duì)象均在入組第1天（干預(yù)前）和第30天（干預(yù)后）取口腔標(biāo)本（咽拭子、齦上菌斑），比較不同的口腔干預(yù)措施對(duì)口腔呼吸道需氧致病細(xì)菌定植率與HAP發(fā)病率的影響； HAP患者收集痰標(biāo)本，采用重復(fù)序列聚合酶鏈反應(yīng)技術(shù)（repetitive element polymerase chain reaction, rep-PCR）對(duì)口腔和痰標(biāo)本分離菌株行同源性研究。 【結(jié)果】 1．不同口腔干預(yù)措施對(duì)長(zhǎng)期住院患者口腔呼吸道需氧致病細(xì)菌定植率及HAP發(fā)病率的影響： (1)試驗(yàn)組口腔干預(yù)前后咽部呼吸道需氧致病細(xì)菌定植率分別為58.06%及32.26%，口腔干預(yù)前后齦上菌斑定植率分別為55.17%及27.59%，差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)； （2）對(duì)照組口腔干預(yù)前后咽部呼吸道需氧致病細(xì)菌定植率分別為54.84%及32.26%，口腔干預(yù)前后齦上菌斑定植率分別為53.57%及28.57%，差異亦均具有統(tǒng)計(jì)學(xué)意義(P0.05)； （3）試驗(yàn)組與對(duì)照組半年內(nèi)HAP發(fā)病率分別為10.20/1000住院日及14.12/1000住院日，差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.口腔內(nèi)需氧致病定植細(xì)菌與院內(nèi)獲得性肺炎(HAP)病原菌的同源性研究： (1)咽部需氧致病細(xì)菌定植率為56.45%，，牙菌斑定植率為54.39%，其中G-桿菌占66.27%，G+球菌占33.73%，分離最多的細(xì)菌依次為銅綠假單胞菌、金黃色葡萄球菌、鮑曼不動(dòng)桿菌； （2）rep-PCR顯示36株HAP病原菌中26株與口腔內(nèi)定植菌具有100%同源性。 【結(jié)論】 1.每日應(yīng)用復(fù)方氯己定和生理鹽水行口腔清潔均可以減少口腔呼吸道需氧致病細(xì)菌定植率，但長(zhǎng)期應(yīng)用復(fù)方氯己定較生理鹽水可以減少HAP的發(fā)生率； 2.長(zhǎng)期住院的老年患者口腔內(nèi)需氧致病菌定植率較高，尤其G-桿菌； 3.口腔內(nèi)需氧致病定植細(xì)菌是HAP病原菌重要的貯存庫(kù)。
[Abstract]:[objective] to study the effect of different oral intervention measures on the colonization rate of aerobic bacteria in oral respiratory tract and the incidence of hospital acquired pneumonia (HAP) in long-term inpatients.To study the homology between oral aerobic pathogenic bacteria and HAP pathogenic bacteria at gene level.[methods] Sixty-two elderly patients (65 years old) were randomly divided into two groups: the experimental group (n = 31) and the control group (n = 31). The experimental group was given compound chlorhexidine twice a day to clean the oral cavity, and the control group was given normal saline twice a day to clean the oral cavity.Oral specimens (pharynx swabs) were collected on day 1 (before intervention) and day 30 (after intervention).To compare the effects of different oral interventions on the colonization rate and incidence of HAP in oral respiratory tract aerobic bacteria, the sputum samples were collected from patients with HAP.Repeat element polymerase chain reaction (rep-PCR) was used to study the homology of isolated strains from oral and sputum samples.[results]1.Effects of different oral interventions on the colonization rate of aerobic bacteria and the incidence of HAP in oral respiratory tract of long-term inpatients:1) before and after oral intervention, the colonization rates of aerobic bacteria in pharynx respiratory tract were 58.06% and 32.26%, respectively. The colonization rates of supragingival plaque before and after oral intervention were 55.17% and 27.59, respectively. The difference was statistically significant (P 0.05).2) in the control group, the colonization rates of aerobic bacteria in respiratory tract of pharynx before and after oral intervention were 54.84% and 32.26%, respectively, and the colonization rates of supragingival plaque were 53.57% and 28.57% respectively before and after oral intervention. The difference was also statistically significant (P 0.05).(3) the incidence of HAP in the experimental group and the control group in half a year was 10.20 / 1000 hospitalization days and 14.12 / 1000 hospitalization days, respectively. The difference was statistically significant (P 0.05).2.Study on homology between oral aerobic pathogenic bacteria and nosocomial pneumonia HAPs.(1) the colonization rate of aerobic bacteria in pharynx was 56.455.The colonization rate of dental plaque was 54.39. Among them, G- bacillus accounted for 66.27g cocci and 33.73.The most isolated bacteria were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii.26 of 36 strains of HAP had 100% homology with oral colonization bacteria.[conclusion]1.Oral cleaning with compound chlorhexidine and normal saline could reduce the colonization rate of aerobic bacteria in oral respiratory tract, but long-term application of compound chlorhexidine could reduce the incidence of HAP compared with normal saline.2.The colonization rate of aerobic bacteria in the oral cavity of the elderly patients with long-term hospitalization was higher, especially G- bacillus.3.Oral aerobic bacterial colonization is an important reservoir of HAP pathogens.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.1

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