危重症科患者呼吸道细菌定植情况及醋酸氯己定清除细菌定植作用  

Distribution of bacterial colonization in respiratory tract and effect of chlorhexidine diacetate oral hygiene on bacterial colonization in critical care patients

作　　者：闵东[1] 谭若铭[1] 瞿洪平[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院危重症科,上海200025

出　　处：《诊断学理论与实践》2013年第4期457-461,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:观察呼吸危重症科(RICU)患者痰液标本检出细菌的定植情况,探讨醋酸氯己定(CHX)对RICU患者及有创机械通气患者呼吸道细菌定植率的影响。方法:对2009年1月至2011年8月入院的180例RICU患者进行前瞻性分析,将患者随机分为2组,分别用生理盐水(NS)和CHX清洁口腔。所有患者于入RICU当天及此后每7 d或临床怀疑呼吸道感染时留取痰液标本,将标本接种、培养后,采用法国生物梅里埃公司细菌鉴定仪进行细菌学鉴定及纸片扩散法(K-B法)分析其呼吸道细菌类型、细菌定植率及耐药性变化特点。结果:RICU所分离的菌株耐药性高,尤以多重耐药菌增加显著,其中鲍曼不动杆菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌(MRSA)为RICU中最常见的细菌。CHX组患者的呼吸道细菌总定植率较NS组明显降低(45.05%比71.91%,P=0.000 3),且其MRSA及铜绿假单胞菌的定植率亦均较NS组明显降低(6.59%比16.85%,P=0.032 0;8.79%比21.35%,P=0.018 3)。在有创机械通气患者中,CXH组的细菌总定植率及MRSA、鲍曼不动杆菌、铜绿假单胞菌定植率也明显较NS组低。结论:使用0.05%的CHX进行口咽部清洁,可降低RICU患者特别是有创机械通气患者的呼吸道细菌定植率。Objective： To investigate the impact of oral hygiene with 0.05% chlorhexidine diacetate on bacterial colo- nization in respiratory tract of critical care patients and its effect on reducing the incidence of colonization in invasive me- chanical ventilation patients. Methods： A prospective study of 180 patients enrolled at Respiratory Intensive Care Unit （RICU） from January 2009 to August 2011 was performed. Patients were randomly divided into two groups using normal saline （NS） or chlorhexidine diacetate （CHX） for oral hygiene, respectively. Sputum specimens were collected at the first and every seven days and days with suspected respiratory infection. The cultured microbial colonies were tested by the bacterial identification system （bioM6rieux, French） and disk diffusion method （KB method） to analysis the types of respira- tory tract bacteria, the incidence of bacterial colonization and drug resistance characteristics. Results： The bacterial strains isolated had high drug resistance; Acinetobactor baumannii, Stenotrophomonas maltophilia, Pseudomonas aerugi- nosa, Klebsiella pneumoniae and Methicillin-resistant Staphylococcus aureus （MRSA） were the most commonly seen bacte- ria in RICU patients. The colonization incidence of respiratory tract in CHX group was lower than that in NS group （41/91 vs 64/89, P=O.000 3）. The incidences of colonization of MRSA and Pseudomonas aeruginosa in CHX group were lower than that in NS group. For invasive mechanical ventilation patients, the colonization incidences of MRSA, Acinetobactor baumannii, and Pseudomonas aeruginosa in respiratory tract in CXH group were much lower than that in NS group. Con- clusions： Bacterial colonization incidence could be reduced by the use of 0.05% chlorhexidine diacetate for oral hygiene, especially in invasive mechanical ventilation patients.

关 键 词：醋酸氯己定 细菌定植 呼吸道感染 危重症科 

分 类 号：R181.32[医药卫生—流行病学]