不同浓度氯己定口腔护理液对机械通气病人抑菌效果及呼吸机相关性肺炎防治效果研究
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摘要
[目的]探讨不同浓度氯己定口腔护理液对机械通气病人的抑菌效果以及呼吸机相关性肺炎(VAP)的防治效果。[方法]采用随机数字表法将120例机械通气治疗病人随机分为3组各40例,对照组采用生理盐水进行口腔护理,低浓度氯己定组应用0.12%的氯己定进行口腔护理,高浓度氯己定组应用2%氯己定进行口腔护理。7d后比较口腔护理效果,记录3组受试者VAP发生情况、机械通气时间、入住ICU时间、住院时间以及死亡情况并进行比较。[结果]干预7d后,3组受试者细菌阳性率、菌落数、牙菌斑指数、VAP发生率、机械通气时间、入住ICU时间、住院时间比较差异均有统计学意义(P<0.05)。[结论]机械通气病人口腔护理中应用氯己定溶液有利于提高抑菌效果,缩短住院时间,降低VAP发生率,且0.12%浓度的氯己定溶液效果更优。
Objective:To explore the bacteriostasis effect of different concentrations of chlorhexidine oral nursing solution on mechanical ventilation patients and the prevention and treatment effect for ventilator associated pneumonia(VAP).Methods:A total of 120 patients with mechanical ventilation were randomly divided into 3 groups by random number method.The patients in control group were treated with normal saline for oral nursing.The patients in low concentration of chlorhexidine group were treated with 0.12%of chlorhexidine in oral nursing,and 2% of chlorhexidine was used in oral nursing in the high concentration of chlorhexidine group.After 7 d,the effect of oral nursing was compared,and the incidence of VAP,mechanical ventilation time,ICU time,hospitalization and death were recorde and compared among the 3 groups.Results:After 7 dintervention,the positive rate of bacteria,the number of colonies,the plaque index,the incidence of VAP,the time of admitting mechanical ventilation,the time of admitting ICU and the time of hospitalization among the 3 groups were statistically significant(P<0.05).Conclusions:The application of chlorhexidine solution in the oral nursing of mechanical ventilation patients could improve the bacteriostasis effect,shorten the time of hospitalization,reduce the incidence of VAP,and the 0.12%chlorhexidine solution is more effective.
Objective:To explore the bacteriostasis effect of different concentrations of chlorhexidine oral nursing solution on mechanical ventilation patients and the prevention and treatment effect for ventilator associated pneumonia(VAP).Methods:A total of 120 patients with mechanical ventilation were randomly divided into 3 groups by random number method.The patients in control group were treated with normal saline for oral nursing.The patients in low concentration of chlorhexidine group were treated with 0.12%of chlorhexidine in oral nursing,and 2% of chlorhexidine was used in oral nursing in the high concentration of chlorhexidine group.After 7 d,the effect of oral nursing was compared,and the incidence of VAP,mechanical ventilation time,ICU time,hospitalization and death were recorde and compared among the 3 groups.Results:After 7 dintervention,the positive rate of bacteria,the number of colonies,the plaque index,the incidence of VAP,the time of admitting mechanical ventilation,the time of admitting ICU and the time of hospitalization among the 3 groups were statistically significant(P<0.05).Conclusions:The application of chlorhexidine solution in the oral nursing of mechanical ventilation patients could improve the bacteriostasis effect,shorten the time of hospitalization,reduce the incidence of VAP,and the 0.12%chlorhexidine solution is more effective.
引文
[1]夏菁,代云,龙丹玲,等.气管切开患者不同浓度洗必泰口腔护理的效果分析[J].中外医学研究,2017,15(8):76-77.
[2]殷胜芝.洗必泰口腔护理与呼吸机相关性肺炎发生率相关性的Meta分析[J].中国实用护理杂志,2015,31(4):277-283.
[3]RAOMES K,ROSEN K.The effect of chlorhexidine bathing on rates of nosocomial infections among the critically ill population:an analysis of current clinical research and recommendations for practice[J].Dimensions Crit Care Nurse,2016,35(2):84-91.
[4]香映芳,罗月荷,陈莉莉,等.气管插管患者口腔护理干预联合不同浓度洗必泰预防VAP的临床效果分析[J].中国现代药物应用,2016,10(13):245-247.
[5]黄家莲,黄雪芳.2%洗必泰护理血透双腔留置管的效果评价[J].中国医药指南,2012,10(14):56-57.
[6]HAYDARI M,BARDAKCI A G,KOLDSLAND O C,et al.Comparing the effect of 0.06%~0.12%and 0.2%chlorhexidine on plaque,bleeding and side effects in an experimental gingivitis model:aparallel group,double masked randomized clinical trial[J].BMC Oral Health,2017,17(1):118.
[7]BERCHIER C E,SLOT D E,VAN DER WEKJDEN G A.The efficacy of 0.12%chlorhexidine mouth rinse compared with 0.2%on plaque accumulation and periodontal parameters;a systematic review[J].J Clin Periodontol,2010,37(9):829-839.
[8]KALIL A C,METERSKY M L,KLOMPAS M,et al.Executive summary:management of adults with hospital-acquired and ventilator-associated pneumonia[J].Clin Infect Dis,2016,63(5):575-582.
[9]SALEEM H G M,SEERS C A,SABRI A N,et al.Dental plaque bacteria with reduced susceptibility to chlorhexidine are multidrug resistant[J].BMC Microbiol,2016,16(9):214.
[10]爦IM爦EK M,DUMAN R.Investigation of effect of 1,8-cineole on antimicrobial activity of chlorhexidine gluconate[J].Pharmacognosy Res,2017,9(3):234-237.
[11]陈飞文,杜和平,沈波.3种口腔护理液对气管插管患者口腔护理效果的对比研究[J].中国初级卫生保健,2014,28(1):112.
[12]唐慧婷,卢惠娟,杨晓莉,等.口腔冲洗用于气管插管危重患者口腔护理效果的meta分析[J].中华护理杂志,2013,48(11):965-970.
[13]DAVIES B M,PPTEL H C.Systematic review and meta-analysis of preoperative antisepsis with combination chlorhexidine and povidone-iodine[J].Surg J(NY),2016,2(3):e70-e77.
[14]Macias J H,Arreguin V,Munoz J M,et al.Chlorhexidine is a better antiseptic than povidone iodine and sodium hypochlorite because of its substantive effect[J].Am J Infect Control,2013,41(7):634-637.
[15]刘静,李小平,张翠梅,等.改良口腔护理法在急性肾衰竭少尿期的应用[J].长春中医药大学学报,2013,29(5):899-900.
[16]ZHANG T T,TANG S S,FU L J.The effectiveness of different concentrations of chlorhexidine for prevention of ventilator associated pneumonia:a meta-analysis[J].J Clin Nurse,2014,23(11/12):1461-1475.
[17]莫红平,丘宇茹,肖秀红,等.ICU气管插管患者呼吸机相关性肺炎危险因素及护理对策[J].国际护理学杂志,2013,32(3):552-554.
[18]王叶,柳书悦,郭艳,等.经口气管插管患者2种口腔护理的效果Meta分析[J].护理学报,2014,11(11):50-58.
[19]MIMOZ O,LUCET J C,KERFORNE T,et al.Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol,with and without skin scrubbing,for prevention of intravascular catheter-related infection(CLEAN):an open-label,multicenter,randomized,controlled,two-by-two factorial trial[J].Lancet,2015,386(10008):2069-2077.
[2]殷胜芝.洗必泰口腔护理与呼吸机相关性肺炎发生率相关性的Meta分析[J].中国实用护理杂志,2015,31(4):277-283.
[3]RAOMES K,ROSEN K.The effect of chlorhexidine bathing on rates of nosocomial infections among the critically ill population:an analysis of current clinical research and recommendations for practice[J].Dimensions Crit Care Nurse,2016,35(2):84-91.
[4]香映芳,罗月荷,陈莉莉,等.气管插管患者口腔护理干预联合不同浓度洗必泰预防VAP的临床效果分析[J].中国现代药物应用,2016,10(13):245-247.
[5]黄家莲,黄雪芳.2%洗必泰护理血透双腔留置管的效果评价[J].中国医药指南,2012,10(14):56-57.
[6]HAYDARI M,BARDAKCI A G,KOLDSLAND O C,et al.Comparing the effect of 0.06%~0.12%and 0.2%chlorhexidine on plaque,bleeding and side effects in an experimental gingivitis model:aparallel group,double masked randomized clinical trial[J].BMC Oral Health,2017,17(1):118.
[7]BERCHIER C E,SLOT D E,VAN DER WEKJDEN G A.The efficacy of 0.12%chlorhexidine mouth rinse compared with 0.2%on plaque accumulation and periodontal parameters;a systematic review[J].J Clin Periodontol,2010,37(9):829-839.
[8]KALIL A C,METERSKY M L,KLOMPAS M,et al.Executive summary:management of adults with hospital-acquired and ventilator-associated pneumonia[J].Clin Infect Dis,2016,63(5):575-582.
[9]SALEEM H G M,SEERS C A,SABRI A N,et al.Dental plaque bacteria with reduced susceptibility to chlorhexidine are multidrug resistant[J].BMC Microbiol,2016,16(9):214.
[10]爦IM爦EK M,DUMAN R.Investigation of effect of 1,8-cineole on antimicrobial activity of chlorhexidine gluconate[J].Pharmacognosy Res,2017,9(3):234-237.
[11]陈飞文,杜和平,沈波.3种口腔护理液对气管插管患者口腔护理效果的对比研究[J].中国初级卫生保健,2014,28(1):112.
[12]唐慧婷,卢惠娟,杨晓莉,等.口腔冲洗用于气管插管危重患者口腔护理效果的meta分析[J].中华护理杂志,2013,48(11):965-970.
[13]DAVIES B M,PPTEL H C.Systematic review and meta-analysis of preoperative antisepsis with combination chlorhexidine and povidone-iodine[J].Surg J(NY),2016,2(3):e70-e77.
[14]Macias J H,Arreguin V,Munoz J M,et al.Chlorhexidine is a better antiseptic than povidone iodine and sodium hypochlorite because of its substantive effect[J].Am J Infect Control,2013,41(7):634-637.
[15]刘静,李小平,张翠梅,等.改良口腔护理法在急性肾衰竭少尿期的应用[J].长春中医药大学学报,2013,29(5):899-900.
[16]ZHANG T T,TANG S S,FU L J.The effectiveness of different concentrations of chlorhexidine for prevention of ventilator associated pneumonia:a meta-analysis[J].J Clin Nurse,2014,23(11/12):1461-1475.
[17]莫红平,丘宇茹,肖秀红,等.ICU气管插管患者呼吸机相关性肺炎危险因素及护理对策[J].国际护理学杂志,2013,32(3):552-554.
[18]王叶,柳书悦,郭艳,等.经口气管插管患者2种口腔护理的效果Meta分析[J].护理学报,2014,11(11):50-58.
[19]MIMOZ O,LUCET J C,KERFORNE T,et al.Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol,with and without skin scrubbing,for prevention of intravascular catheter-related infection(CLEAN):an open-label,multicenter,randomized,controlled,two-by-two factorial trial[J].Lancet,2015,386(10008):2069-2077.
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