重症监护病房中选择性消化道脱污染对院内获得性肺炎的临床价值

【】　目的　探讨在重症监护病房（intonsivecanetmit，ICU）行选择性消化道脱污染（selectivedigestivedecontamination，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<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　Todiscusstheclinicalvalueofselectivedigestivedecontaminationintheintensivecareunit(ICU).　Methods　FromJanuary2007toJanuary2010,376criticallyillpatientswererandomlydividedintotwogroups.Patientsinthecontrolgroupreceivedconventionaloralcavitynursingtreatment,andthoseinthetreatmentgroupunderwenttheselectivedigestivedecontamination.Then,wecomparedthecurativeeffectparametersofthesetwokindsofproceduresforthetwogroupsofpatients.　Results　Forpatientsinthetreatmentgroup,therateofhospital-acquiredpneumonia(HAP)was18.4%,theoccurringtimeofHAPwas(7.2±3.2)days,thetimeofretainingartificialgaschannel(tracheacannula/incision)was(10.5±3.8)days,thetimeofmechanicalventilationwas(8.4±3.1)days,ICUstaytimewas(14.7±4.8)days,andthemortalityratewas11.6%.Forthecontrolgroup,thecorrespondentparameterswererespectively30.1%,(5.6±3.6)days,(12.5±4.6)days,(10.2±4.2)days,(17.2±6.2)days,and19.4%.Thedifferencesoftheseparametersbetweenthetwogroupsweresignificant(P<0.05).　Conclusion　ForpatientsintheICU,theselectivedigestivedecontaminationcaneffectivelycontroltheoccurrenceofHAP,improvepatientconditions,reducehospitalizationtime,anddecreasemortalityrate.