过氧化氢深漱口对全身麻醉气管插管患者肺部感染的预防效果研究  

Study on the preventive effect of deep gargle with hydrogen peroxide for pulmonary infections in patients undergoing endotracheal intubation under general anesthesia

作　　者：沈黎红[1] 赵斌江[1] 关雷[1] 冯枫[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京100038

出　　处：《中华医院感染学杂志》2015年第14期3304-3306,共3页Chinese Journal of Nosocomiology

基　　金：北京市自然科学基金资助项目(7112555)

摘　　要：目的分析普外科择期手术全身麻醉的患者在气管插管后发生肺部感染情况,术前采用过氧化氢深漱口,以降低肺部感染发生率。方法将普外科2013年1-12月择期手术全麻的患者共294例随机分为试验组150例和对照组144例;对照组的患者在手术前其口腔不给予任何预防措施,试验组患者均给予1.5%过氧化氢深漱口,观察并记录两组患者的术后一周肺部感染发生率。结果对照组144例患者术后一周发生肺部感染22例,感染率15.3%,试验组150例患者术后一周发生肺部感染6例,感染率4.0%,试验组患者术后感染率明显低于对照组,差异有统计学意义(P<0.05);过氧化氢深漱口前后的患者口腔菌落数发生明显变化,而且气管导管的前端菌落数明显下降,差异有统计学意义(P<0.05),感染患者送检痰液标本培养出病原菌共42株,试验组检出9株,占21.4%,对照组检出33株占78.6%,检出病原菌主要为金黄色葡萄球菌、鲍氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌、肺炎克雷伯菌、表皮葡萄球菌、大肠埃希菌、真菌等。结论过氧化氢口腔深漱口可以降低患者口腔中的病原菌含量,也可以明显降低择期手术全身麻醉患者在气管插管后的肺部感染,值得临床推广应用。OBJECTIVE To analyze the situation of lung infections after intubation in patients undergoing selective surgery under general anesthesia and the use of hydrogen peroxide for deep gargle to reduce the incidence of pulmonary infections.METHODS The 294 patients in the general surgical department in Jan.-Dec.2013 who underwent general anesthesia for selective surgery were randomly divided into the experimental group（n=150）and the control group（n=144）.Patients in the control group before surgery did not receive any measures to prevent infections.Patients in the experimental group were given 1.5% hydrogen peroxide for deep gargle for 2times.The incidence of pulmonary infections at one week after operation was observed and recorded for the two groups.RESULTS Totally 22 out of 144 patients in the control group had pulmonary infections at postoperative one week,the infections rate was 15.3%;while 6out of 150 patients in the experimental group had pulmonary infections,the infections rate was 4.0%,showing that the infection rate in the experiment group was significantly lower than in the control group（P〈0.05）.The oral bacterial count changed significantly and the bacterial count at the front end of the tracheal tube significantly declined after deep gargle with hydrogen peroxide（P〈0.05）.Sputum culture detected a total of 42 pathogenic strains,including 9strains（21.4%）in the experimental group and 33strains（78.6%）in the control strains.The pathogens mainly included Staphylococcus aureus,Acinetobacter baumannii,Pseudomonas aeruginosa,Enterobacter cloacae,Klebsiella pneumoniae,Staphylococcus epidermidis,Escherichia coli,and fungi.CONCLUSION Deep gargle with hydrogen peroxide can significantly reduce bacteria levels in the mouth and pulmonary infections after incubation in patients receiving selective surgery under general anesthesia,which is worthy of clinical application.

关 键 词：过氧化氢 口腔深漱口 择期手术 气管插管 肺部感染 

分 类 号：R563.1[医药卫生—呼吸系统]