Clinical Value of Selective Digestive Decontamination for Hospital Acquired Pneumonia in Intensive Care Unit_West China Medical Journal

Authors：

ZHAN Pingfan , ZHOU Long , XIE Yuqian , LUO Fuying , ZHANG Li

Intensive Care Unit, the People’s Hospital of Xichang City, Xichang, Sichuan 615000, P. R. China;

Corresponding author：

Keywords：

重症监护病房; 选择性消化道脱污染; 院内获得性肺炎

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【摘要】　目的　探讨在重症监护病房（intonsive cane tmit，ICU）行选择性消化道脱污染（selective digestive decontamination，SDD）的临床实用价值。　方法　选取2007年1月—2010年1月危重症患者376例，随机分为两组，对照组予常规口腔护理治疗，治疗组予选择性消化道脱污染治疗，比较两组患者病情疗效的参数。　结果　治疗组院内获得性肺炎发生率为18.4%、院内获得性肺炎发生时间（7.2±3.2）d、人工气道（气管插管/切开）保留天数（10.5±3.8）d、机械通气天数（8.4±3.1）d、入住ICU天数（14.7±4.8）d、病死率11.6%；对照组院内获得性肺炎发生率为30.1%、院内获得性肺炎发生时间（5.6±3.6）d、人工气道（气管插管/切开）保留天数（12.5±4.6）d、机械通气天数（10.2±4.2）d、入住ICU天数（17.2±6.2）d、病死率19.4%；两组比较差异均有统计学意义（P lt;0.05）。　结论　在ICU内行选择性消化道脱污染可有效控制院内获得性肺炎，改善患者病情，减少住院天数，降低病死率。
【Abstract】　Objective　 To discuss the clinical value of selective digestive decontamination in the intensive care unit (ICU).　Methods　 From January 2007 to January 2010, 376 critically ill patients were randomly divided into two groups. Patients in the control group received conventional oral cavity nursing treatment, and those in the treatment group underwent the selective digestive decontamination. Then, we compared the curative effect parameters of these two kinds of procedures for the two groups of patients.　Results　 For patients in the treatment group, the rate of hospital-acquired pneumonia (HAP) was 18.4%, the occurring time of HAP was (7.2±3.2) days, the time of retaining artificial gas channel (trachea cannula / incision) was (10.5±3.8) days, the time of mechanical ventilation was (8.4±3.1) days, ICU stay time was (14.7±4.8) days, and the mortality rate was 11.6%. For the control group, the correspondent parameters were respectively 30.1%, (5.6±3.6) days, (12.5±4.6) days, (10.2±4.2) days, (17.2±6.2) days, and 19.4%. The differences of these parameters between the two groups were significant (P lt;0.05).　Conclusion　 For patients in the ICU, the selective digestive decontamination can effectively control the occurrence of HAP, improve patient conditions, reduce hospitalization time, and decrease mortality rate.

Citation： ZHAN Pingfan,ZHOU Long,XIE Yuqian,LUO Fuying,ZHANG Li. Clinical Value of Selective Digestive Decontamination for Hospital Acquired Pneumonia in Intensive Care Unit. West China Medical Journal, 2011, 26(6): 868-870. doi: Copy

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2. 　金咏絮, 林其昌, 黄志, 等. 我国院内获得性肺炎诊治现状[J]. 医学综述, 2009, 15(17): 2625-2627.
3. 　周新. 美国2005年院内获得性肺炎诊治指南要点与解读[J]. 中国实用内科杂志, 2006, 26(4): 295-296.
4. 　王吉耀, 廖二元, 黄从新, 等. 内科学[M]. 2版. 北京: 人民卫生出版社, 2010: 82-87.
5. 　狄韵漫. 综合ICU医院感染监测的效果分析[J]. 华西医学, 2010, 25(5): 994-995.
6. 　高光霞. ICU病房院内下呼吸道感染病原菌分布情况分析[J]. 华西医学, 2010, 25(3): 465-467.
7. 　Stoutenbeek CP, Bouter H, Schipprrs EF, et al. Seiected decontamination of the digestive tractin severely burned pediatric patients[J]. Acta Anaesth Belg, 1983, 34(7): 193-209.
8. 　应明英, 罗传兴. 实用危重病监测治疗学[M]. 北京: 人民卫生出版社, 1998: 301-320.
9. 　李丽华, 王丽. 综合ICU呼吸机相关性肺炎的预防及护理措施[J]. 华西医学, 2010, 25(9): 1745-1746.
10. 　付贵峰, 莫联权, 史竟. 机械通气发生呼吸机相关性肺炎危险因素的研究[J]. 临床肺科杂志, 2007, 12(7): 716-717.
11. 　齐莹. 口腔护理预防医院内获得性肺炎的临床研究[J]. 临床医药实践杂志, 2007, 16(10): 1012-1013.
12. 　杨帆. 不同口腔护理方法预防机械通气患者呼吸机相关性肺炎的疗效观察[J]. 卫生职业教育, 2010, 28(10): 147-149.
13. 　Jean L, Vincot, Zandstra DF, et al. Selective decontamination of the digestive tract: use of the correct antibiotics is cracial[J]. Anon Inpharma, 2003: 1407(1): 16.
14. 　Van Enckevort PJ, Zwaveling JH, Bottema JT, et al. Cost effectiveness of Selective decontamination of the digestive tract in liver transplant pationts[J]. N Engl J Med, 2009, 360(5): 20-31.
15. 　刘宇鹏. 选择性消化道及口咽脱污染可降低重症监护病房患者病死率[J]. 中华医学杂志, 2009, 89(22): 1532.
16. 　Van Saene HKF, Hammond JM, Potgieter PD, et al. Long-term effects of selective decontamination on antimicrobial resistance[J]. Crit Care Med, 1992, 20(8): 691-703.
17. 　杨宝峰, 苏定冯, 周宏灏. 药理学[M]. 7版. 北京: 人民卫生出版社, 2008: 404-439.

West China Medical Journal

Clinical Value of Selective Digestive Decontamination for Hospital Acquired Pneumonia in Intensive Care Unit

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