洗必泰刷牙冲洗法预防气管插管病人呼吸机相关性肺炎的效果

目的 探讨洗必泰刷牙冲洗法对预防气管插管病人呼吸机相关性肺炎(VAP)的作用.方法 将200例经口气管插管病人随机分为2组:试验组100例,对照组100例.试验组采用改良口腔护理方法(0.12%洗必泰30ml+刷牙+冲洗),对照组采用传统棉球擦拭口腔护理法.比较2组病人呼吸机相关性肺炎的发生率、机械通气时间、住ICU时间及住院时间.结果 试验组VAP发生率、机械通气时间、住重症监护室(ICU)及住院时间方面优于对照组(均p<0.001).结论 经口气管插管病人用改良口腔护理方法,能够彻底清洁口腔,有效预防和减少VAP的发生率,缩短住院时间、降低死亡率.     

声门下冲洗引流在预防VAP中的作用

目的:观察可冲洗气管导管在预防呼吸机相关性肺炎中的作用,并探计相应的护理措施。方法:将收入ICU需行机械通气的病人随机分为二组,采用可冲洗气管导管接受声门下积液冲洗为引流组,采用普通气管导管为常规治疗组,定期从口咽部、声门下分泌物和下呼吸道获取细菌学样本,记录行机械通气的天数和发生VAP的病例数结果。常规治疗组VAP发病率为53.3％,平均发生时间8.4±3.0d积液引流组VAP发病率为25.7％,平均发生时间11.6±4.1d经统计学处理P<0.05,二组结果有显著性差异。结论:声门下积液的仔在是引起机体发生VAP的主要原因之一,应用可冲洗气管导管行声门下积液冲洗引流可以明显减少VAP的发生率,是一种简单而有效的方法。     

声门下冲洗引流在预防VAP中的作用

目的观察可冲洗气管导管在预防呼吸机相关性肺炎中的作用,并探讨相应的护理措施.方法将收入ICU需行机械通气的病人随机分为二组,采用可冲洗气管导管接受声门下积液冲洗为引流组,采用普通气管导管为常规治疗组,定期从口咽部、声门下分泌物和下呼吸道获取细菌学样本,记录行机械通气的天数和发生VAP的病例数.结果常规治疗组VAP发病率为53.3%,平均发生时间8.4±3.0 d;积液引流组VAP发病率为25.7%,平均发生时间11.6±4.1 d.经统计学处理P＜0.05,二组结果有显著性差异.结论声门下积液的存在是引起机体发生VAP的主要原因之一,应用可冲洗气管导管行声门下积液冲洗引流可以明显减少VAP的发生率,是一种简单而有效的方法.     

口插管患者口腔冲洗预防VAP的研究进展

探讨口腔冲洗在经口插管机械通气患者中预防呼吸机相关性肺炎的效果,从口腔冲洗液、口腔冲洗方法、口腔冲洗频次、口腔冲洗评价方法及评价工具、注意事项及影响因素等方面详细的阐述了口腔冲洗的研究现状。     

不同护理液口腔护理联合声门下冲洗对气管插管患者的影响

目的 观察生理盐水和灭菌注射用水2种护理液分别进行口腔护理和声门下冲洗对气管插管患者的影响.方法 选取2018年7月-2019年10月我院重症监护病房100例行气管插管机械通气的危重患者,采用随机数字表法分为对照组和观察组各50例.两组患者在给予预防呼吸机相关性肺炎的集束化护理基础上,对照组每8 h采用生理盐水行口腔护...     

不同时机气囊上滞留物冲洗预防气管插管病人VAP的效果观察

[目的]探讨不同时机气囊上滞留物冲洗对ICU气管插管病人发生呼吸机相关性肺炎(VAP)的影响。[方法]选择81例在我院ICU住院治疗并接受气管插管行机械通气的病人,随机分为对照组和干预组,两组均落实预防VAP的相关措施,干预组在每次口腔护理后给予氯己定液强化气囊上滞留物冲洗操作。比较两组病人VAP发生率、病死率及下呼吸道分泌物细菌学菌株分布的结果,比较气囊上滞留物引流量和下呼吸道分泌物细菌学菌株数量。[结果]干预组VAP的发生率低于对照组(P0.05),两组病人的死亡率差异无统计学意义(P0.05);干预组气囊上滞留物每日引流量多于对照组(P0.05);两组病人机械通气后各观察点的下呼吸道分泌物细菌培养结果均以革兰阴性杆菌为主,但是机械通气48h后干预组培养出的细菌菌株数量明显少于对照组(P0.05)。[结论]ICU气管插管病人口腔护理后用氯己定液强化气囊上滞留物冲洗能降低VAP的发生率和下呼吸道细菌菌株数量。     

气管插管患者口腔冲洗法预防感染效果观察

目的探讨口腔冲洗法对气管插管患者患者实施口腔护理的效果。方法通过观察口腔感染发生率,比较碘伏冲洗法和碘伏棉球擦拭法预防口腔感染的效果。结果观察组采用有效碘浓度为500 mg/L碘伏溶液冲洗法进行气管插管患者口腔护理,口腔感染发生率为8.3%。对照组用相同浓度的碘伏溶液沾湿棉球擦拭进行气管插管患者口腔护理,口腔感染率为18.3%。结论采用碘伏溶液冲洗法对ICU气管插管患者实施口腔护理,预防口腔感染的效果优于擦拭法,且操作简便。     

洗必泰预防剖宫产术后感染

作者在剖宫产术中采用洗必泰 (Ｃｈｌｏｒｈｅｘｉ ｄｉｎｅ)冲洗宫腔、腹腔及腹壁切口 ,预防术后感染效果显著 ,现介绍如下。1　资料与方法1 996年 1月～ 1 999年 1 2月共行剖宫产术980例 ,产妇平均 2 5岁 ,随机分为 2组 ,试验组采用关腹前洗必泰溶液冲洗宫腔、腹腔及腹壁切口 ,共 360例。对照组为 62 0例 ,对照方法为单纯随机抽样。试验组与对照组孕妇术前感染诱因基本情况一致 ,例Ｈｂ <90 ｇ/Ｌ、阴道炎、羊水性状Ⅱ～Ⅲ度、破膜时间≥ 1 2ｈ、产程时间 ,差异无显著性 ,具有可比性。方法 :试验组剖宫产术中在胎儿、胎盘娩出 ,清理腹腔及…     

冲吸式口护吸痰管联合洗必泰冲洗在经口气管插管机械通气患者的口腔护理效果

目的:探究冲吸式口护吸痰管联合洗必泰冲洗在经口气管插管机械通气患者的口腔护理效果。方法:回顾性选取2018年7月-2019年6月我院ICU经口气管插管机械通气患者60例作为研究对象,根据所给护理方案不同分为研究组和对照组各30例,研究组给予冲吸式口护吸痰管联合洗必泰冲洗护理,对照组给予常规口腔护理。观察对比两组患者的护理效果。结果:护理后研究组患者菌斑指数评分、临床肺部感染评分(CPIS)均显著低于对照组(P0.05);研究组患者呛咳发生率、呼吸机相关性肺炎发生率均明显低于对照组(P0.05);研究组患者口腔并发症发生率明显低于对照组(P0.05)。结论:冲吸式口护吸痰管联合洗必泰冲洗在经口气管插管机械通气患者的口腔护理效果显著,降低呛咳和呼吸机相关性肺炎发生率,减少并发症情况。     

Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis

OBJECTIVE: To assess the efficacy of topical chlorhexidine for prevention of ventilator-associated pneumonia (VAP) in a meta-analysis. DATA SOURCE: Computerized PubMed and MEDLINE search supplemented by manual searches for relevant articles. STUDY SELECTION: Randomized controlled trials evaluating efficacy of topical chlorhexidine applied to the oropharynx vs. placebo or standard care for prevention of VAP. DATA EXTRACTION: Data were extracted on patient population, inclusion and exclusion criteria, diagnostic criteria for VAP, form and concentration of topical chlorhexidine used, incidence of VAP, and overall mortality. DATA SYNTHESIS: Data on incidence of VAP and mortality were abstracted as dichotomous variables. Pooled estimates of the relative risk and 95% confidence intervals were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I. Subgroup analyses were used to explore heterogeneity. RESULTS: Seven randomized controlled trials met the inclusion criteria. Topical chlorhexidine resulted in a reduced incidence of VAP (relative risk, 0.74; 95% confidence interval, 0.56-0.96; p=.02) using a fixed effects model. Using the more conservative random effects model, the point estimate was similar (relative risk, 0.70; 95% confidence interval, 0.47-1.04; p=.07), but the results failed to achieve statistical significance. The I test showed moderate heterogeneity. Subgroup analysis showed that the benefit of chlorhexidine was most marked in cardiac surgery patients (relative risk, 0.41; 95% confidence interval, 0.17-0.98; p=.04). There was no mortality benefit with chlorhexidine although the sample size was small. CONCLUSIONS: Our analysis showed that topical chlorhexidine is beneficial in preventing VAP; the benefit is most marked in cardiac surgery patients. A large randomized trial is needed to determine the impact of topical chlorhexidine on mortality.     

Chest physiotherapy for the prevention of ventilator-associated pneumonia

OBJECTIVE: Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. DESIGN: Prospective controlled systematic allocation trial. SETTING: Tertiary teaching hospital ICU. PATIENTS AND PARTICIPANTS: Sixty adult patients intubated and mechanically ventilated for at least 48 h. INTERVENTIONS: Chest physiotherapy (intervention group) or sham physiotherapy (control group). MEASUREMENTS AND RESULTS: Control and intervention groups were well matched for age, sex, and admission PaO(2)/FiO(2) ratio, APACHE II score, and Glasgow Coma Score. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. VAP was assessed daily by combined clinical assessment and the clinical pulmonary infection score (CPIS). VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR = 0.14, 95% CI 0.03 to 0.56, P = 0.02). After adjustment was made by logistic regression for other important variables (APACHE II score, duration of mechanical ventilation, presence of tracheostomy, and GCS score), chest physiotherapy was independently associated with a reduced occurrence of VAP (adjusted OR = 0.16, 95% CI 0.03 to 0.94, P = 0.02). CONCLUSIONS: In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.     

护理干预对老年呼吸机相关性肺炎发生的预防作用分析

目的探讨护理干预对老年呼吸机相关性肺炎发生的预防作用。方法选取本院接诊的80例接受机械通气患者作为研究对象。按照随机抽签法分为观察组和对照组各40例,2组患者进行常规对症治疗,包括气管插管、化痰止咳、纠正酸碱失衡及水电解质紊乱、解痉平喘、抗生素治疗等。对照组采用常规护理,观察组采用护理干预。观察2组患者机械通气时间和住院时间,动脉血气分析,生命体征,肺功能指标,呼吸机相关性肺炎发生率及病死率。结果观察组机械通气时间和住院时间低于对照组;pH值、p(O_2)值均高于对照组,p(CO_2)低于对照组(P0.05);Sa O2显著高于对照组(P0.05),心率、呼吸频率低于对照组(P0.05);2组患者肺功能指标PEF、PEEPi均改善,且观察组改善程度优于对照组(P0.05);呼吸机相关性肺炎发生率及病死率均低于对照组(P0.05)。结论加强护理干预在对老年呼吸机相关性肺炎发生具有显著的预防作用,能够促进患者恢复,缩短机械通气治疗时间,从而减少肺部感染。     

Impact of oral hygiene on prevention of ventilator-associated pneumonia in neuroscience patients

Ventilator-associated pneumonia is one of the most frequent complications among critically ill patients. Growth of pathogenic bacteria in dental plaque may serve as the source of these infections. This performance improvement initiative evaluated an aggressive oral care approach to prevent the accumulation of plaque containing bacteria. Our data support the use of these oral care measures and deep oral-pharyngeal suctioning for the prevention of aspiration of oral contents.