Zhang Pingji, Xia Guoguang, Dai Li, Cheng Yang, Wang Zhuo
Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China.
Exp Ther Med. 2019 Jul;18(1):531-536. doi: 10.3892/etm.2019.7614. Epub 2019 May 24.
Effects of laryngoscope-assisted and cotton ball wiping methods on the prevention of oral and pulmonary infection in patients receiving mechanical ventilation were compared to explore the influence of the two methods on high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT). In total, 152 patients who underwent mechanical ventilation in the ICU of Beijing Jishuitan Hospital from May 2005 to January 2018 were assigned and equally divided into two groups: 76 patients who had their oropharynxes scrubbed and rinsed by an electric toothbrush under direct vision by the use of a laryngoscope were selected as the laryngoscope group, and 76 patients who received the conventional cotton ball wiping method and the flushing method for oropharyngeal cleaning were assigned in the cotton ball group. Detection of serum hs-CRP and PCT levels in a 2-ml sample of fasting venous blood was performed on both groups of patients before hospitalization, and on the 5th and 10th day of hospitalization. The incidence rate of oral infection and ventilator-associated pneumonia, as well as the length of the cleaning time were recorded. The incidence rate of oral infection and ventilator-associated pneumonia in the laryngoscope group was statistically much lower than that in the cotton ball group (P<0.05). Before the experiment, there was no significant difference in the hs-CRP and PCT levels between the two groups (P>0.050), whereas the laryngoscope group had significantly lower hs-CRP and PCT levels at the 5th and 10th day of hospitalization than those in the cotton ball group (P<0.05). The hs-CRP and PCT levels at the three time-points in the same group were statistically different (P<0.05). In conclusion, oropharyngeal scrub and rinse by an electric toothbrush assisted by a laryngoscope, can not only better prevent oral infection and reduce the incidence of ventilator-associated pneumonia, but it also has shorter cleaning time and results in lower levels of inflammatory factors, which make this method beneficial in the clinic.
比较喉镜辅助法与棉球擦拭法对机械通气患者口腔及肺部感染预防的效果，探讨两种方法对高敏C反应蛋白（hs-CRP）和降钙素原（PCT）的影响。选取2005年5月至2018年1月在北京积水潭医院ICU接受机械通气的152例患者，将其随机等分为两组：76例在喉镜直视下使用电动牙刷对口咽部进行刷洗和冲洗的患者作为喉镜组，76例采用传统棉球擦拭法及冲洗法进行口咽部清洁的患者作为棉球组。两组患者均于入院前、入院第5天和第10天采集2 ml空腹静脉血样本检测血清hs-CRP和PCT水平。记录口腔感染和呼吸机相关性肺炎的发生率以及清洁时间。喉镜组口腔感染和呼吸机相关性肺炎的发生率显著低于棉球组（P<0.05）。实验前，两组hs-CRP和PCT水平无显著差异（P>0.05），而喉镜组在住院第5天和第10天的hs-CRP和PCT水平显著低于棉球组（P<0.05）。同一组三个时间点的hs-CRP和PCT水平差异有统计学意义（P<0.05）。综上所述，喉镜辅助电动牙刷进行口咽部刷洗和冲洗，不仅能更好地预防口腔感染、降低呼吸机相关性肺炎的发生率，而且清洁时间短，炎症因子水平低，临床应用效果良好。
