口腔内呼吸道需氧致病菌定植与老年院内获得性肺炎相关性的临床研究

发布时间：2018-04-06 03:09

本文选题：复方氯己定　切入点：院内获得性肺炎　出处：《首都医科大学》2013年硕士论文

【摘要】：【目的】研究不同口腔干预措施对长期住院患者口腔呼吸道需氧致病细菌定植率及医院内获得性肺炎（HAP）发病率的影响；从基因水平研究口腔内需氧致病定植细菌与HAP病原菌的同源性。【方法】将我院62名老年患者（65岁）随机分为试验组（n=31）和对照组（n=31），试验组每日两次予复方氯己定清洁口腔,对照组每日两次予生理盐水清洁口腔，研究对象均在入组第1天（干预前）和第30天（干预后）取口腔标本（咽拭子、龈上菌斑），比较不同的口腔干预措施对口腔呼吸道需氧致病细菌定植率与HAP发病率的影响； HAP患者收集痰标本，采用重复序列聚合酶链反应技术（repetitive element polymerase chain reaction, rep-PCR）对口腔和痰标本分离菌株行同源性研究。【结果】 1．不同口腔干预措施对长期住院患者口腔呼吸道需氧致病细菌定植率及HAP发病率的影响： (1)试验组口腔干预前后咽部呼吸道需氧致病细菌定植率分别为58.06%及32.26%，口腔干预前后龈上菌斑定植率分别为55.17%及27.59%，差异均具有统计学意义(P0.05)；（2）对照组口腔干预前后咽部呼吸道需氧致病细菌定植率分别为54.84%及32.26%，口腔干预前后龈上菌斑定植率分别为53.57%及28.57%，差异亦均具有统计学意义(P0.05)；（3）试验组与对照组半年内HAP发病率分别为10.20/1000住院日及14.12/1000住院日，差异具有统计学意义(P0.05)。 2.口腔内需氧致病定植细菌与院内获得性肺炎(HAP)病原菌的同源性研究： (1)咽部需氧致病细菌定植率为56.45%，，牙菌斑定植率为54.39%，其中G-杆菌占66.27%，G+球菌占33.73%，分离最多的细菌依次为铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌；（2）rep-PCR显示36株HAP病原菌中26株与口腔内定植菌具有100%同源性。【结论】 1.每日应用复方氯己定和生理盐水行口腔清洁均可以减少口腔呼吸道需氧致病细菌定植率，但长期应用复方氯己定较生理盐水可以减少HAP的发生率； 2.长期住院的老年患者口腔内需氧致病菌定植率较高，尤其G-杆菌； 3.口腔内需氧致病定植细菌是HAP病原菌重要的贮存库。
[Abstract]:[objective] to study the effect of different oral intervention measures on the colonization rate of aerobic bacteria in oral respiratory tract and the incidence of hospital acquired pneumonia (HAP) in long-term inpatients.To study the homology between oral aerobic pathogenic bacteria and HAP pathogenic bacteria at gene level.[methods] Sixty-two elderly patients (65 years old) were randomly divided into two groups: the experimental group (n = 31) and the control group (n = 31). The experimental group was given compound chlorhexidine twice a day to clean the oral cavity, and the control group was given normal saline twice a day to clean the oral cavity.Oral specimens (pharynx swabs) were collected on day 1 (before intervention) and day 30 (after intervention).To compare the effects of different oral interventions on the colonization rate and incidence of HAP in oral respiratory tract aerobic bacteria, the sputum samples were collected from patients with HAP.Repeat element polymerase chain reaction (rep-PCR) was used to study the homology of isolated strains from oral and sputum samples.[results]1.Effects of different oral interventions on the colonization rate of aerobic bacteria and the incidence of HAP in oral respiratory tract of long-term inpatients:1) before and after oral intervention, the colonization rates of aerobic bacteria in pharynx respiratory tract were 58.06% and 32.26%, respectively. The colonization rates of supragingival plaque before and after oral intervention were 55.17% and 27.59, respectively. The difference was statistically significant (P 0.05).2) in the control group, the colonization rates of aerobic bacteria in respiratory tract of pharynx before and after oral intervention were 54.84% and 32.26%, respectively, and the colonization rates of supragingival plaque were 53.57% and 28.57% respectively before and after oral intervention. The difference was also statistically significant (P 0.05).(3) the incidence of HAP in the experimental group and the control group in half a year was 10.20 / 1000 hospitalization days and 14.12 / 1000 hospitalization days, respectively. The difference was statistically significant (P 0.05).2.Study on homology between oral aerobic pathogenic bacteria and nosocomial pneumonia HAPs.(1) the colonization rate of aerobic bacteria in pharynx was 56.455.The colonization rate of dental plaque was 54.39. Among them, G- bacillus accounted for 66.27g cocci and 33.73.The most isolated bacteria were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii.26 of 36 strains of HAP had 100% homology with oral colonization bacteria.[conclusion]1.Oral cleaning with compound chlorhexidine and normal saline could reduce the colonization rate of aerobic bacteria in oral respiratory tract, but long-term application of compound chlorhexidine could reduce the incidence of HAP compared with normal saline.2.The colonization rate of aerobic bacteria in the oral cavity of the elderly patients with long-term hospitalization was higher, especially G- bacillus.3.Oral aerobic bacterial colonization is an important reservoir of HAP pathogens.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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