Talesh Kourosh Taheri, Gargary Reza Movassaghi, Arta Seyed Ahmad, Yazdani Javad, Roshandel Monireh, Ghanizadeh Milad, Kafil Hossein Samadi, Mousavi Mir Naser Seyyed
Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Assistant Professor, Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.
J Clin Diagn Res. 2017 Aug;11(8):PC08-PC12. doi: 10.7860/JCDR/2017/29575.10396. Epub 2017 Aug 1.
In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea.
To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries.
In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests.
In the mupirocin group, 27.2% of the subjects were carriers of in the nasal cavity but no was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of in the nasal cavity but there was no change in the number of counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001).
Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of and other gram-negative bacteria.
在口腔颌面外科手术中，进行鼻气管插管是为了增加外科医生进入口腔的机会。在鼻气管插管过程中，创伤风险高于口气管插管，因为导管要穿过鼻腔黏膜，这可能会使细菌进入气管。
评估鼻气管插管前后使用2%鼻用莫匹罗星软膏对降低口腔颌面外科手术插管并发症的效果。
在本单盲随机对照临床试验中，44例患者被随机分为两组。在鼻气管插管前8至10小时，用无菌拭子从患者鼻孔前庭和鼻中隔取样进行培养。第1组在双侧鼻孔前庭和鼻中隔涂抹2%鼻用莫匹罗星软膏。第2组不进行干预。全身麻醉和拔管后，从导管远端4厘米处制备微生物培养物并进行药敏试验。此外，还比较了两组患者鼻出血的严重程度、鼻气管插管后经鼻呼吸的难易程度。数据采用适当的统计检验进行分析。
在莫匹罗星组，27.2%的受试者鼻腔携带[此处原文缺失具体细菌名称]，但拔管后鼻气管导管远端未检测到[该细菌名称]。在对照组，18.2%的受试者鼻腔携带[此处原文缺失具体细菌名称]，但鼻气管导管远端的[该细菌名称]数量没有变化（p值<0.001）。拔管后，莫匹罗星组和对照组分别有18.2%和22.7%的受试者出现严重出血（p值=0.001）。在莫匹罗星组和对照组，分别有86.4%和59.1%的受试者拔管顺利（p值=0.044）。在莫匹罗星组和对照组，分别有9.1%和63.7%的受试者在恢复意识后立即出现呼吸困难，以及9.1%和54.6%的受试者在拔管后3小时出现呼吸困难（p值=0.001）。
鼻气管插管前使用莫匹罗星除了可降低[此处原文缺失具体细菌名称]和其他革兰氏阴性菌定植风险外，还可减少鼻腔插管的并发症。
