小棉签和大棉签用于经鼻气管插管消毒效果的微生物学比较：一项随机试验。
Microbiological comparison of the disinfecting efficacy of small and large cotton swabs in nasotracheal intubation: a randomized trial.
机构信息
Department of Microbiology, Aichi Gakuin University School of Dentistry, 1-100 Kusumotocho, Chikusa-ku, Nagoya, 464-8650, Japan.
Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori- dori, Chikusa-ku, Nagoya, 464-8651, Japan.
出版信息
BMC Anesthesiol. 2024 Nov 14;24(1):414. doi: 10.1186/s12871-024-02804-2.
BACKGROUND
Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy.
METHODS
Patients classified as American Society of Anesthesiologists-physical status (ASA-PS) class 1 or 2 scheduled for general anesthesia with NTI were randomly assigned to either a large cotton swabs (LCS) or fine cotton swabs (FCS) group in this randomized controlled trial (RCT)." After anesthesia, a fine cotton swab was inserted into the inferior nasal meatus in both groups to collect bacteria (sample A). Next, the nasal cavity was disinfected with LCS or FCS according to the patient group. Bacteria were collected by inserting a fine cotton swab into the inferior nasal meatus (sample B). After surgery, bacteria were collected from the endotracheal tube tip using a fine cotton swab in both groups (sample C). The samples were cultured for 24 hours, and the colonies from samples A-C were counted. The changes in bacteria count between samples A and B and samples A and C were determined. Nasal bleeding from cotton swab insertion was assessed as a secondary outcome. Student's t-tests, a chi-square independence test, and Mann-Whitney U tests were used for the statistical analysis. The statistical significance level was set at p < 0.05.
RESULTS
Between samples A and B, the change in bacteria count was 7.2% (1.4-26.1%) (median[interquartile range]) in the LCS group and 6.9% (0.9-22%) in the FCS group (p = 0.90). Between samples A and C, the change in bacteria count was 7.5% (0.2-44%) in the LCS group and 8.3% (0.3-39%) in the FCS group (p = 0.55). We examined 62 subjects in each group (LCS and FCS), and samples A, B, and C were collected from all participants in both groups. Nasal bleeding occurred in 42/62 in the LCS group and 22/62 in the FCS group (p < 0.01).
CONCLUSION
Cotton swab thickness did not impact disinfection efficacy, but large swabs increased the risk of nasal bleeding. We recommend FCS for nasal disinfection prior to NTI in ASA 1-2 patients, as they reduce bleeding risk without compromising disinfection.
TRIAL REGISTRATION
UMIN-CTR (registration no. UMIN000051495), June 30, 2023.
背景
在需要清晰进入手术部位的手术中以及在有呼吸问题的患者中，需要进行经鼻插管（NTI）。本研究旨在探讨不同大小的棉拭子在进行 NTI 前对鼻腔消毒的效果，假设较小的拭子可以在保持消毒效果的同时最大限度地减少出血。
方法
本随机对照试验（RCT）将 ASA 身体状况（PS）分级 1 或 2 级、拟全身麻醉行 NTI 的患者随机分为大棉拭子（LCS）组或细棉拭子（FCS）组。在麻醉后，两组均使用细棉拭子插入下鼻甲采集细菌（样本 A）。然后，根据患者分组用 LCS 或 FCS 对鼻腔进行消毒。用细棉拭子插入下鼻甲采集鼻腔细菌（样本 B）。手术后，两组均使用细棉拭子从气管插管尖端采集细菌（样本 C）。将样本培养 24 小时，对样本 A-C 的菌落进行计数。比较样本 A 与 B、样本 A 与 C 之间细菌计数的变化。将棉拭子插入时的鼻腔出血作为次要结果进行评估。采用 Student's t 检验、卡方独立性检验和 Mann-Whitney U 检验进行统计学分析。统计显著性水平设为 p<0.05。
结果
在样本 A 与 B 之间，LCS 组细菌计数的变化为 7.2%（1.4-26.1%）（中位数[四分位距]），FCS 组为 6.9%（0.9-22%）（p=0.90）。在样本 A 与 C 之间，LCS 组细菌计数的变化为 7.5%（0.2-44%），FCS 组为 8.3%（0.3-39%）（p=0.55）。每组我们检查了 62 名受试者（LCS 和 FCS），并且在两组的所有参与者中均采集了样本 A、B 和 C。LCS 组有 42/62 例发生鼻腔出血，FCS 组有 22/62 例（p<0.01）。
结论
棉拭子的厚度并不影响消毒效果，但大棉拭子会增加鼻腔出血的风险。我们建议在 ASA 1-2 级患者中进行 NTI 前使用 FCS 进行鼻腔消毒，因为它们可以降低出血风险，同时不影响消毒效果。
试验注册
UMIN-CTR（注册号 UMIN000051495），2023 年 6 月 30 日。
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