氯己定擦浴预防ICU严重多发伤患者院内感染的临床研究

目的 讨论氯己定擦浴对ICU严重多发伤患者院内感染的影响,以降低院内感染发生率.方法 选取2007年6月-2013年5月本院救治的1 67例严重多发伤患者为研究对象,采用随机数字表法将其分为两组,试验组87例,对照组80例.试验组采用氯己定全身擦浴2次,对照组采用传统方法以75％乙醇消毒2次、碘伏消毒1次,两组消毒范围和手法一致.比较两组患者消毒后各项指标的差异.结果 试验组和对照组入院时、24、48、72、96 h的皮肤病原菌定植率比较,差异无统计学意义.试验组和对照组24、48、72、96 h皮肤病原菌存在率、皮肤病原菌清除率比较,差异无统计学意义.入院及4d皮肤病原菌构成为金黄色葡萄球菌占55％,奇异变形菌占27％,鲍曼不动杆菌占13％,铜绿假单胞菌占2％,肺炎克雷伯菌占3％.对于鲍曼不动杆菌呼吸机相关性肺炎（VAP）而言,试验组比对照组下降了0.14％;对于导管相关血流感染（CR-BSI）而言,试验组比对照组下降了0.38％;对于导管相关尿路感染（CR-UTI）而言,试验组相对下降了0.42％,但差异均无统计学意义.结论 短期内使用氯己定擦浴并不能明显降低ICU严重多发伤患者感染率,临床还需进一步研究其长期使用效果.

Clinical Study on Chlorhexidine Bath in the Prevention of ICU Nosocomial Infection in Severe Multiple Trauma Patients

Objective To discuss the effects of chlorhexidine bath on ICU No Socomial infection in patients with severe multiple trauma,so as to reduce the incidence of nosocomial infection. Methods 167 cases of severe multiple trauma patients were selected From June 2007 to May 2013 in our hospital as the research subjects, and randomly divided into experimental group and control group, experimental group used chlorhexidine whole body bath 2 times, the control group used traditional methods with 75 % ethanol disinfection and iodine volts disinfection 1 time. The disinfection range was consistent in two groups, and the outcomes were compared. Results There were no differences between the experimental group and control group on admission,24,48, 72,and 96 h in skin pathogen rate and skin pathogen clearance. On hospitalization and 4 days the skin pathogens were staphylococcus aureus （ 55%）, singular deformation bacteria （ 27%）, acinetobacter baumannii （ 13%）, pseudomonas aeruginosa （2. 0%）. Cholrine bath reduced acinetobacter baumannii associated ventilation pneumonitis （VAP） 0.14 ~,decreased acquired catheter-related bloodstream infections （CR-BSI） 0.38% and acquired catheter-related urinary tract infections （CR-UTI） 0. 42%, but had no significant differences. Conclusion The use of chlorhexidine bath can＇t obviously reduce the chances of infection in ICU patients with severe multiple trauma in a short time and its long-term effect needs for further research.