改良式体位结合0.02%氯己定口腔护理对重症呼吸机相关性肺炎患者的预防效果

目的 研究改良式体位结合0.02%氯己定口腔护理对重症呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的防治效果。 方法 选取2016年2月-2018年2月在成都医学院附属第二医院进行治疗的经口气管插管行机械通气时间>48 h的VAP患者170例,采用随机数字法分为2组。给予常规护理组患者常规口腔护理,给予结合护理组患者改良体位联合浓度为0.02%氯己定溶液进行口腔护理,比较患者护理后的肺部感染情况、ICU住院时间、口腔炎症情况、机械通气时间及GCS评分,对患者病菌发生率、痰痂形成率、VAP发生率进行统计。 结果 结合护理组患者在护理后的肺部感染评分和ICU住院时间显著低于常规护理组患者(P<0.05);结合护理组的口腔炎症发生率显著低于常规护理组(P<0.05);结合护理组的口咽定植菌和气管内定植菌发生率均显著低于常规护理组(P<0.05);结合护理组患者在护理后的痰痂形成率和VAP发生率显著低于常规护理组患者(P<0.05)。 结论 使用改良式体位和浓度为0.02%氯己定溶液能更好地降低重症患者在机械通气的情况下发生呼吸机相关性肺炎的几率,对患者的康复及疾病治疗提供很大的帮助。 

Analysis of preventive effect of modified posture combined with 0.02% chlorhexidine oral care on ventilator-associated pneumonia in critically ill patients

Objective To study the preventive and curative effects of improved posture combined with 0.02% chlorhexidine oral care on ventilator-associated pneumonia (VAP). Methods Totally 170 patients with mechanical ventilation time >48 h after breath tube intubation who were treated in the ICU of our hospital from February, 2016 to February, 2018 were selected. Regular oral cavity nursing was given to patients in the routine nursing group, and improved position in combination with concentration of 0.02% chlorhexidine acetate solution for oral care to patients in the combined nursing group. Pulmonary infection after nursing, length of stay in ICU, oral inflammation, mechanical ventilation time and GCS score, incidence of patients with bacteria, sputum scab formation rate, and incidence of VAP were calculated. Results The pulmonary infection score and length of stay in ICU in the combined care group were significantly lower than those in the conventional care group (P<0.05). The incidence of oral inflammation in the combined care group was significantly lower than that in the conventional care group (P<0.05). The incidence of oropharyngeal and intratracheal colonization in the combined care group was significantly lower than that in the conventional care group (P<0.05). The sputum scab formation rate and VAP incidence in the combined nursing group were significantly lower than those in the conventional nursing group (P<0.05). Conclusion The use of modified postures and concentration of 0.02% chlorhexidine solution can better reduce the incidence of ventilator-associated pneumonia in severe patients under the condition of mechanical ventilation, providing great help for patients' rehabilitation and disease treatment.