洗必泰擦浴联合阿米卡星滴鼻在预防重症监护病房呼吸机相关性肺炎中的应用

发布时间：2018-02-24 08:20

本文关键词： 洗必泰阿米卡星重症监护病房呼吸机相关性肺炎　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨应用洗必泰擦浴联合阿米卡星滴鼻在预防重症监护病房（IntensiveCareUnit,ICU）呼吸机相关性肺炎（VentilatorAssociatedPneumonia，VAP）中的作用。方法：将2010年10月至2011年12月进行有创机械通气治疗的162例患者按照1:1:1比例随机分为3组：清水擦浴组（54例），单纯清水全身擦浴，每日两次至转出ICU；洗必泰擦浴组（54例），单纯2%洗必泰全身擦浴，每日两次至转出ICU；联合处理组（54例），给予2%洗必泰全身擦浴，每日两次至转出ICU，，联合0.02g/次阿米卡星滴鼻,每日3次，连续滴鼻1周后停用。三组均使用5%碳酸氢钠溶液口腔护理（2次/日），观察3组经上述处理后各自的VAP发生率以及致病菌耐药情况变化。同时观察应用洗必泰擦浴后临床不良事件发生情况。结果：清水擦浴组VAP发生率为48.1%(26/54),洗必泰擦浴组VAP发生率为25.9%（14/54），联合处理组VAP发生率22.2%（12/54），洗必泰擦浴组和联合处理组VAP发生率明显低于清水擦浴组（P0.05），而洗必泰擦浴组和联合处理组两组间VAP发生率无明显差异（P0.05）。对于ICU常见耐药菌多重耐药鲍曼不动杆菌（MDRAB）和耐甲氧西林金黄色葡萄球菌（MRSA）的感染率，洗必泰擦浴组和联合处理组较清水擦浴组明显减低（P0.05）。分析VAP致病菌耐药情况变化，我们选取ICU最常见VAP致病菌7种（铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌、大肠埃希菌、嗜麦芽假单胞菌、金黄色葡萄球菌、肠球菌），比较清水擦浴组、洗必泰擦浴组和联合处理组分离出的同种致病菌耐药情况，结果提示三组分离出的致病菌耐药率无明显差异（P0.05）。108例采用洗必泰擦浴患者仅2例出现接触性皮炎（1.85%），未发生过敏性休克，医护人员接触后未发生哮喘和呼吸困难。结论：应用洗必泰全身擦浴可安全有效预防ICU呼吸机相关性肺炎发生，特别是降低了MDRAB、MRSA的感染率，未引起细菌耐药率的升高；洗必泰擦浴联合阿米卡星滴鼻较单纯洗必泰擦浴在预防ICU呼吸机相关性肺炎上未见显著优势，短期应用阿米卡星滴鼻虽未引起细菌耐药率的升高，但随着时间推移局部应用抗生素往往是引起致病菌耐药性升高的高危因素之一，为防止细菌耐药率的升高，不推荐长期应用阿米卡星滴鼻用于ICU预防VAP的发生。
[Abstract]:Objective: to investigate the role of chlorhexidine in combination with amikacin nasal drops in the prevention of ventilator associated pneumonia (VAPs) in intensive care unit (ICU). Methods: a total of 162 patients undergoing invasive mechanical ventilation from October 2010 to December 2011 were randomly divided into 3 groups according to the ratio of 1: 1: 1: 1: 1: 54 cases in the clean water bath group and 54 cases in the clean water group. Two times a day to transfer out of ICU; chlorhexidine bath group 54 cases, only 2% whole body bath, 2 times a day to transfer to ICU; combined treatment group of 54 cases, given 2% chlorhexidine whole body bath, twice a day to transfer out of ICU, combined with 0.02 g / time Amikacin nasal drops, Three times a day, The oral nursing care of 5% sodium bicarbonate solution was used twice a day in the three groups. The incidence of VAP and the drug resistance of pathogenic bacteria were observed in the three groups after the above treatment. At the same time, the changes of drug resistance of chlorhexidine were observed. Clinical adverse events after bath. Results: the incidence of VAP in the clean water bath group was 48.1% and that in the chlorhexidine bath group was 25.914 / 54. The incidence of VAP in the combined treatment group was 22.2g / 54.The incidence of VAP in the chlorhexidine bath group and the combined treatment group was significantly lower than that in the clean water bath group (P 0.05), while the incidence rate in the chlorhexidine group was significantly lower than that in the clean water bath group (P 0.05). There was no significant difference in the incidence of VAP between the two groups compared with the combined treatment group (P 0.05). The infection rate of Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (ICU) was detected. After analyzing the changes of drug resistance of VAP pathogens, we selected the most common VAP pathogens of ICU (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae). Escherichia coli, Pseudomonas maltophilia, Staphylococcus aureus, Enterococcus spp., were compared with the drug resistance of the control group, the chlorhexidine group and the combined treatment group. The results showed that there was no significant difference in drug resistance rate of pathogenic bacteria isolated from the three groups. Only 2 patients with contact dermatitis and no anaphylactic shock were found in 108 patients treated with chlorhexidine. No asthma or dyspnea was found in medical staff after contact. Conclusion: it is safe and effective to use chlorhexidine in the whole body to prevent ICU ventilator-associated pneumonia, especially to reduce the infection rate of MRSA, but not to increase the rate of bacterial resistance. There was no significant advantage in preventing ICU ventilator-associated pneumonia by taking chlorhexidine in combination with amikacin nasal drops. Although the short-term application of amikacin did not cause the increase of bacterial drug resistance rate, there was no significant difference in the prevention of ICU ventilator-associated pneumonia. However, local use of antibiotics is often one of the high risk factors for the increase of drug resistance of pathogenic bacteria. In order to prevent the increase of bacterial drug resistance rate, it is not recommended to use amikacin nasal drops for long-term ICU to prevent the occurrence of VAP.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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