Faculty of Healthcare Vesalius, University College Ghent, Ghent, Belgium.
Lancet Infect Dis. 2011 Nov;11(11):845-54. doi: 10.1016/S1473-3099(11)70127-X. Epub 2011 Jul 26.
We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults.
Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I(2) test.
14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98).
This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients.
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我们进行了系统评价和随机效应荟萃分析，以评估与不使用这些防腐剂的口腔护理相比，用洗必泰或聚维酮碘进行口腔护理对成人呼吸机相关性肺炎发生率的影响。
通过 PubMed、CINAHL、Web of Science、CENTRAL 以及补充手动搜索来确定研究。纳入的研究为接受洗必泰或聚维酮碘口腔护理的机械通气成年患者的随机试验。采用 Mantel-Haenszel 模型计算相对风险（RR）和 95%置信区间（CI），采用 I(2)检验评估异质性。
纳入 14 项研究（2481 例患者），其中 12 项研究评估洗必泰的效果（2341 例患者），2 项研究评估聚维酮碘的效果（140 例患者）。总体而言，使用防腐剂可显著降低呼吸机相关性肺炎的风险（RR 0.67；95%CI 0.50-0.88；p=0.004）。洗必泰的应用效果显著（RR 0.72；95%CI 0.55-0.94；p=0.02），而聚维酮碘的效果尚不清楚（RR 0.39；95%CI 0.11-1.36；p=0.14）。使用洗必泰的试验存在中度异质性（I(2)=29%；p=0.16），而评估聚维酮碘使用的试验存在高度异质性（I(2)=67%；p=0.08）。对于 2%洗必泰（RR 0.53，95%CI 0.31-0.91）和心脏外科研究（RR 0.41，95%CI 0.17-0.98）的亚组分析，效果更为显著。
本分析表明，口腔使用防腐剂可预防呼吸机相关性肺炎，具有有益效果。临床医生在为气管插管患者提供口腔护理时应考虑这些发现。
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