比较刷牙与洗必泰口腔卫生措施对预防呼吸机相关性肺炎的影响：一项随机研究。
Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.
作者信息
de Lacerda Vidal Claudia Fernanda, Vidal Aurora Karla de Lacerda, Monteiro José Gildo de Moura, Cavalcanti Aracele, Henriques Ana Paula da Costa, Oliveira Márcia, Godoy Michele, Coutinho Mirella, Sobral Pollyanna Dutra, Vilela Claudia Ângela, Gomes Bárbara, Leandro Marta Amorim, Montarroyos Ulisses, Ximenes Ricardo de Alencar, Lacerda Heloísa Ramos
机构信息
Tropical Medicine Health Sciences Center, Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Av. Professor Moraes Rego, 1235 Hospital das Clínicas - Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil.
Department of Pathology, Institute of Biological Sciences, Universidade de Pernambuco, Hospital de Câncer de Pernambuco, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil.
出版信息
BMC Infect Dis. 2017 Jan 31;17(1):112. doi: 10.1186/s12879-017-2188-0.
BACKGROUND
Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP).
METHODS
The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco - Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria.
RESULTS
Seven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064).
CONCLUSIONS
The results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although without statistical significance.
TRIAL REGISTRATION
Retrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).
背景
医院获得性肺炎与接受机械通气患者的牙菌斑及口咽定植有关。通过预防病原菌定植来阻断这一过程，是预防呼吸机相关性肺炎（VAP）的一种潜在方法。
方法
本研究设计为一项前瞻性随机试验，旨在验证对于在临床/外科及心脏病重症监护病房（ICU）接受机械通气的成年患者，与仅使用0.12%洗必泰溶液而不刷牙的口腔卫生措施相比，刷牙加用0.12%洗必泰凝胶的口腔卫生措施是否能降低VAP的发生率、机械通气时间、住院时间及ICU死亡率。研究方案已获得伯南布哥联邦大学健康科学中心伦理研究委员会批准——伦理委员会批准证书（CAAE）04300012500005208。由于本研究为随机试验，故采用CONSORT 2010清单标准。
结果
716例患者入住ICU；219例符合纳入标准，最终纳入213例患者；108例被随机分配至对照组，105例被分配至干预组。在整个随访期间，刷牙加0.12%洗必泰凝胶组的VAP发生率较低，尽管差异无统计学意义（p = 0.084）。刷牙组的机械通气平均时间显著缩短（p = 0.018）。关于ICU住院时间和死亡率，差异无统计学意义（p = 0.064）。
结论
研究结果表明，在接受刷牙的患者中，机械通气时间显著缩短，VAP发生率及ICU住院时间有降低趋势，但差异无统计学意义。
试验注册
于巴西临床试验注册中心（巴西临床试验注册处）进行回顾性注册——RBR - 4TWH4M（2016年9月4日）。
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