Zand Farid, Zahed Leili, Mansouri Parisa, Dehghanrad Freshte, Bahrani Maryam, Ghorbani Mohammad
Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Fatemeh Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.
J Crit Care. 2017 Aug;40:318-322. doi: 10.1016/j.jcrc.2017.02.029. Epub 2017 Mar 1.
Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Units (ICUs) which increases the length of ICU stay, duration of mechanical ventilation, and mortality. The present study used an oral care protocol and compared the effects of two different concentrations of chlorhexidine on reduction of oropharyngeal colonization and VAP.
This study was performed on 114 patients from trauma, surgery, neurosurgery, and general ICUs randomly allocated to two groups under oral care with 0.2% and 2% chlorhexidine solution. A multidisciplinary team approved the oral care protocol. Data was collected using a demographic information form, APACHE IV form, Beck oral assessment scale, mucosal-plaque assessment scale, and oropharyngeal swab culture.
The results showed a significant reduction in VAP (p=0.007) and oropharyngeal colonization (p=0.007) in the group under oral care with 2% chlorhexidine solution compared with the other group. However, no significant difference was found between the two groups in terms of oropharyngeal adverse effects (p=0.361).
Oral decontamination with 2% compared to 0.2% chlorhexidine is a more effective method in the prevention of VAP and reduction of oropharyngeal colonization (especially gram-positive).
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中最常见的医院感染，它会增加ICU住院时间、机械通气时间和死亡率。本研究采用口腔护理方案，比较了两种不同浓度的氯己定对减少口咽部定植菌及VAP的效果。
本研究对114例来自创伤、外科、神经外科和综合ICU的患者进行，随机分为两组，分别接受0.2%和2%氯己定溶液的口腔护理。一个多学科团队批准了该口腔护理方案。使用人口统计学信息表、APACHE IV表、贝克口腔评估量表、黏膜菌斑评估量表和口咽拭子培养收集数据。
结果显示，与另一组相比，接受2%氯己定溶液口腔护理的组VAP（p = 0.007）和口咽部定植菌（p = 0.007）显著减少。然而，两组在口咽部不良反应方面无显著差异（p = 0.361）。
与0.2%氯己定相比，2%氯己定进行口腔去污是预防VAP和减少口咽部定植菌（尤其是革兰氏阳性菌）的更有效方法。
