Katayama Yoshinori, Takanishi Hiromi, Sato Yumi, Fujita Satoshi, Enomoto Masahiro
Department of Neonatology, Takatsuki General Hospital, Osaka, Japan.
Emergency Department, Takatsuki General Hospital, Osaka, Japan.
Pediatr Pulmonol. 2021 Aug;56(8):2570-2575. doi: 10.1002/ppul.25451. Epub 2021 May 13.
Oral care using chlorhexidine has been considered useful in reducing the incidence of ventilator-associated pneumonia (VAP) in adult patients. However, no study has proved the effect of oral care in reducing the incidence of VAP in preterm infants.
To investigate the efficacy of oral care using a sponge brush moistened with sterile water in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants METHODS: The bacterial number in the oral cavity was evaluated on-site with the dielectrophoretic impedance measurement system. Bacterial numbers before and after oral care were investigated prospectively. Then, the incidence of early-onset VAP was compared retrospectively between infants who received oral care before re-intubation and those who did not.
The mean bacterial number (cfu/ml) in the oral cavity in infants managed with endotracheal intubation (n = 23), continuous positive airway pressure (n = 38), and high-flow nasal cannula (n = 22) significantly reduced (p < .01) after versus before oral care (4.46 × 10 vs. 1.25 × 10 ; 1.32 × 10 vs. 6.82 × 10 ; and 1.68 × 10 vs. 6.50 × 10 ). The incidence rate of early-onset VAP after re-intubation was 51% (20/39) in patients who did not receive oral care. Then, it significantly decreased to 21% (7/33; p = .009) after receiving oral care.
Oral care with sterile water may be effective in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants.
使用氯己定进行口腔护理被认为有助于降低成年患者呼吸机相关性肺炎（VAP）的发生率。然而，尚无研究证实口腔护理对降低早产儿VAP发生率的效果。
探讨用无菌水湿润的海绵刷进行口腔护理对降低早产儿口腔细菌载量及早发型VAP发生率的效果。
使用介电泳阻抗测量系统对口腔细菌数量进行现场评估。前瞻性地调查口腔护理前后的细菌数量。然后，回顾性比较重新插管前接受口腔护理的婴儿和未接受口腔护理的婴儿早发型VAP的发生率。
经气管插管（n = 23）、持续气道正压通气（n = 38）和高流量鼻导管吸氧（n = 22）的婴儿，口腔护理后口腔平均细菌数（cfu/ml）较护理前显著降低（p <.01）（4.46×10对1.25×10；1.32×10对6.82×10；1.68×10对6.50×10）。未接受口腔护理的患者重新插管后早发型VAP的发生率为51%（20/39）。接受口腔护理后，该发生率显著降至21%（7/33；p = 0.009）。
用无菌水进行口腔护理可能有助于降低早产儿口腔细菌载量及早发型VAP的发生率。
