The Clinical Study on the Prevention of Ventilator-associated Pneumonia by the Early Intensive Oral Care
|Keywords||Ventilator associated pneumonia Endotracheal intubation Mechanicalventilation Oral care Bacteria|
Objective：By improving the existing oral care methods and operating procedures, thisresearch is to explore the early intensive oral care line to the incidce the mouth cavitybacteria quantity and Ventilator associated pneumonia (VAP),who were allprocessing the Mechanical ventilation （MV）through the breath tube intubation.Toassess the effect and quality of improved care method, to further standardize theprocesses and methods of clinical oral care and provide a scientific basis for the MVpatients, to reduce the occurrence of VAP.Methods：The selected70MV patients were randomly divided into experimental groupand control group (35cases respectively), the experimental group using the improvedoral care: oral swab one time immediately before intubation, take a soft bristle brushwash and oral rinse after intubation,3times per day, choose0.1%povidone iodine asthe oral care liquid; Control group: use the traditional oral swab3times per day,choose saline solution as the oral care liquid. Take pharyngeal swab from two groupsof patients to cultivate bacteria count before intubation (experimental group choosebefore oral swab) and after intubation2h、4h、6h、8h; take pharyngeal swab tocultivate bacteria count before and after30minutes after intubation16h、8h、24hthree oral cares; and7d、14d after intubation pharyngeal swab and sputum specimenswere taken to process the qualitative cultivation. At the same time, record two groupsof patients’ cleanness of oral cavity, oral and respiratory indexes of bacteriology, theoral quantity of bacteria, incidence of VAP, the time of MV, the stay-time in ICU,mortality rate and so on. Collect relevant data and apply to statistical analysis.Results：1.70cases of patients,61cases were effective (experimental group31cases andcontrol group30cases),9cases were eliminated because of MV <14days or diedwithin14days. The difference of gender、age、APACHE-Ⅱscore、oral assessmentscore、with basic diseases had no statistical significance between experimental group and control group.2. The bacteriology indicators:(1) The bacteria count before intubation and in6h、8h after intubation had no statistically significant difference between twogroups(P=0.161，0.865,0.159); The bacteria count in2h、4h after Intubation hadstatistically significant difference between two groups (P=0.005,0.014).(2) Thebacteria count in16h、8h、24h after intubation before three oral cares process had nostatistically significant difference between two groups (P=0.159,0.071,0.976); Thebacteria count in16h、8h、24h after intubation after three oral cares process hadstatistically significant difference between two groups(P=0.034,0.016,0.041).(3)Qualitative cultivation of oral swabs show positive in the7day after intubation:,10cases of experimental group（10/31）,18cases of control group（18/30）; There werestatistically significant difference between two groups(P=0.041); Qualitativecultivation of oral swabs show positive in the14day after intubation:,13cases ofexperimental group（13/31）,20cases of control group（20/30）,There were statisticallysignificant difference between two groups(P=0.047).(4) Qualitative cultivation ofsputum specimens show positive in the7day after intubation:13cases ofexperimental group（13/31）,22cases of control group（22/30）, There werestatistically significant difference between two groups(P=0.020); Qualitativecultivation of sputum specimens show positive in the14day after intubation:18casesof experimental group（18/31）,25cases of control group(25/30), There werestatistically significant difference between two groups(P=0.049);(5)The result of oralbacteria cultivation and sputum cultivation is the same bacterium in the7day afterintubation:4cases of experimental group（4/31）,15cases of control group（15/30）,There were statistically significant difference between two groups(P=0.043); Theresult of oral bacteria cultivation and sputum cultivation is the same bacterium in the14day after intubation:4cases of experimental group（4/31）,15cases of controlgroup （15/30）, There were statistically significant difference between twogroups(P=0.031).(6) the result of8patients’ sputum cultivation in15VAP patients isconsistent with the bacteria of mouth cavity(53.33%).3.15examples occur VAP, experimental group4cases account12.9%（4/31）,control group11cases account36.67%（11/30）, the incidence of VAP were statistically significant difference (P=0.040);9cases were died, experimental group4cases account12.9%（4/31）, control group5cases account16.67%（5/30），themortality rate had no statistical significance (P=0.731); the two groups’ Oral cavitycleanness, time the MV of two groups were statistically significant (P=0.001,0.049);the stay-time in ICU of two groups had no statistical significance (P=0.068).4. VAP regression analysis of factor: The single factor analysis of APACHE-Ⅱscore、oral assessment score and MV time were statistically significant between VAPgroup and non VAP group；The single factor of APACHE-Ⅱscore、bacteria count andMV time were put in logistic regression, the results showed that the higher APACHE-Ⅱscore and bacteria count, the higher of the VAP incidence.Conclusion：1. Early intensive oral care can effectively reduce the amount of mouth cavitybacteria, improve the oral cleanliness. reduce the time of MV and the incidence ofVAP.2. Compared with the conventional oral nursing method,early intensive oral careis feasible,and help to improve the oral nursing quality and effect, it is worthy ofclinical application.