中药口咽部及气囊上去污染预防呼吸机相关性肺炎的临床研究

目的观察自制中药制剂口咽部及气囊上去污染对呼吸机相关性肺炎（VAP）的影响。方法将68例机械通气患者随机分为两组，对照组32例给予0．9％氯化钠注射液进行口咽部清洁以及人工气道气囊上冲洗；治疗组38例应用等量中药制剂进行口咽部清洁以及人工气道气囊上冲洗；两组其他治疗措施相同。观察两组患者呼吸机相关肺炎发生的例数、机械通气1周后临床肺部感染评分（CPIS），以及第3、5、7、10日人工气道气囊上滞留物细菌培养情况，并进行统计学处理。结果治疗组VAP发生率为27．7％，显著低于对照组的53．12％（P〈0．05）；机械通气1周后CPIS，治疗组为（4．1＋1．5）分显著低于对照组之（6．7＋1．8）分（P〈0．05）。治疗组气囊上方滞留物含菌量（＋＋＋，＋＋＋＋）较对照组显著减少（P〈O．01），两组患者发生VAP者病原体的构成比差异无统计学意义（P〉0．05）。结论中药制剂口咽部及气囊上去污染对呼吸机相关性肺炎的发生有预防作用。

Study of Decontamination in Balloon and Oropharynx with TCM Decoction on Ventilator-associated Pneumonia

Objective： To observe the effect of the decontamination in ballon and oropharynx with TCM decoc- tion on ventilator-associated pneumonia. Methods： 68 cases were randomly divided into the control group with decontamination by 0.9% sodium chloride injection and the treatment group with the TCM decoction. After treat- ment, some indices were detected and compared between 2 groups including the cases,the CPIS and the bacteri- um in the artificial airway gasbag. Results： The VAP incidence with 27.8% of the treatment group was lower sig- nificantly than that wiht53.12% of the control group （P〈 0.05）. After 1 week of mechanical ventilation,the CPIS with （4.1~1.5） of the treatment gruop was less than that with （6.7~1.8） of the control group （P〈 0.05）. The amount of retention bacteria above the balloon in the treatment group were lower remarkably than those in the controlo group（P〈0.01）. However,there was no obvious difference between 2 groups in the pathogen ratio of the VAP pa- tients（P〈 0.05）. Conclusion： There is the preventive effect of the decontamination in ballon and oropharynx with TCM decoction on ventilator-associated pneumonia.