术前口腔准备对术后呼吸机相关性肺炎发生率的影响

目的 观察高龄体外循环心脏外科手术患者进行术前口腔准备对术后呼吸机相关性肺炎（VAP）发生率的影响。方法 选择高龄（≥65岁）体外循环心脏外科择期手术患者95例，随机分为实验组（n=48）和对照组（n=47），实验组除常规术前准备外，分别于术前1 d进食三餐后、睡前至手术当日使用漱口液漱口；对照组只进行常规术前准备，不予以口腔准备。所有患者在麻醉时实施气管插管，分别在插管前和插管后咽拭子和痰液取样，进行细菌培养和鉴定；比较两组患者术后VAP的发生率。结果 通过口咽拭培养和痰培养，实验组口咽带菌率明显低于对照组，差异有统计学意义（P<0.05）。实验组早发性VAP和总VAP发生率均低于对照组，差异有统计学意义（P<0.05）；但两组间晚发性VAP发生率差异无统计学意义（P>0.05）。结论 术前口腔准备对降低高龄体外循环心脏外科手术患者术后早发性VAP有一定的临床意义。

Effect of pre-operative oral preparation on incidence of ventilator-associated pneumonia after operation

Objective To investigate the effect of pre-operative oral preparation on incidence of ventilator-associated pneumonia (VAP) after cardiopulmonary bypass surgery in elderly patients. Methods Ninety-five patients (≥65 years old) undergoing cardiopulmonary bypass surgery were randomly divided into experiment group (n=48) and control group (n=47). For experiment group, besides conventional preoperative preparation, gargle mouthwash was used after three meals and before sleep on the day before surgery day and before surgery on the surgery day. Besides conventional preoperative preparation, no oral preparation was performed in control group. Tracheal intubation was conducted during anesthesia, oropharyngeal swab samples and sputum samples were collected before intubation and after intubation, and bacteria culture and identification were carried out. The incidences of  VAP after operation were compared between two groups. Results The oropharyngeal infection rate in experiment group was significantly lower than that in control group in oropharyngeal swab culture and sputum culture (P<0.05). The incidences of early-onset VAP and total VAP in experiment group were significantly lower than those in control group (P<0.05), while there was no significant difference in the incidence of late-onset VAP between two groups (P>0.05). Conclusion Pre-operative oral preparation can decrease the incidence of early-onset VAP in elderly patients undergoing cardiopulmonary bypass surgery.