综合ICU气管插管患者口咽清洁度与真菌定植分析简

目的 研究三级医院综合ICU气管插管患者口咽部清洁度与继发真菌定植的关系,为进一步采取治疗、干预措施,减少继发呼吸机相关性肺部真菌感染提供理论依据.方法 选取广西壮族自治区梧州市人民医院2010年10月～2013年9月96例气管插管患者,自插管次日起每天早上观察口腔、会厌部清洁度,同时采集咽拭子、痰标本涂片进行真菌分纯培养、鉴定.结果 经口气管插管患者口咽部清洁度越差,真菌定植率越高;经口气管插管≥5d者比＜5d者口咽清洁度差（62.86％比53.85％）;经口气管插管者口咽清洁度比经鼻插管者差;气管插管时间≥5d者真菌定植率（会厌定植41.67％、下呼吸道定植20.83％）高于插管时间＜5d者（会厌定植27.08％、下呼吸道定植9.38％）,经口气管插管者真菌定植率（会厌定植42.71％、下呼吸道定植22.92％）高于经鼻插管者（会厌定植26.04％、下呼吸道定植7.29％）.结论 综合ICU中气管插管患者受疾病、药物、各种治疗措施的影响口咽部的自洁能力降低,随着气管导管留置时间的延长,口咽清洁度日益恶化,必然会相应增加继发呼吸机相关性肺部真菌感染的风险,应引起重视.

Analysis of oropharyngeal cleanliness and fungal colonization of tracheal intubation patients in comprehensive ICU

Objective To investigate the relationship between the oropharyngeal cleanliness of comprehensive ICU tracheal intubation patients and secondary fungal colonization in tertiary hospitals,so as to provide a theoretical basis for the further treatment,intervention measures,and reduce the secondary ventilator-associated pulmonary fungal infection.Methods 96 tracheal intubation patients from October 2010 to September 2013 in Wuzhou People＇s Hospital were selected to be observed,including the purity observation of oral cavity and epiglottis from intubation in the next day.Meanwhile,the throat swab and sputum fungal smear were collected.At last,the fungi was pure,cultivated and evaluated.Results As orotracheal intubation in patients with purity of the oropharynx became worse,fungal colonization rate grew higher; purity of the oropharynx of the patients whose orotracheal intubation duration ≥ 5 days was worse than those whose duration 〈 5 days （62.86% vs 53.85%）; the oropharynx purity of orotracheal intubation patients was worse than the nasal intubation patients; fungal colonization rate of the patients whose tracheal intubation time ≥ 5 days （epiglottis colonization of 41.67%,lower respiratory tract colonization of 20.83%） was higher than those 〈 5 days （epiglottis in colonization of 27.08%,lower respiratory tract colonization of 9.38%）; fungal colonization rates of the orotracheal intubation patients （epiglottis colonization of 42.71%,lower respiratory tract colonization of 22.92%） were higher than nasal intubation patients （epiglottis colonization of 26.04%,lower respiratory tract colonization of 7.29%）,Conclusion Affected by the disease,drugs,various treatment measures,the ability of the purity of oropharynx of comprehensive ICU tracheal intubation patients reduced.The longer the endotracheal tube stays in the body,the worse the purity of oropharynx becomes,which results in the increase of the secondary ventilator-associated pulmonary fungal infection risk.Therefore,it should be paid more attention to the case.