| Ventilator-associated pneumonia (VAP) is common complication of ventilation, it's morbidity arranges from 9% to 60%. Great advance had made about nosogenesis of VAP in recently ten years, it believed that the VAP caused mainly by colonization of bacteria in oropharyngeal and inhale secretion into lower respiratory tract, which it developed to pneumonia. For preventing VAP with successfully, some measures should be done: (1) Decrease oropharyngeal secretions inhaled into lung. (2) Altering toxicity and number of pathogen in oral. (3) Increase immune ability of patient. All methods on increasing immune ability were failure, and it should not be changed in the new future.Pathogen in oral has great impact with occurrence of VAP. It was considered that selective decontamination of the digestive (SDD) was able to eliminate bacteria of oropharyngeal and intestinal, some randomized trials demonstrated that using SDD can decrease morbidity of VAP from 60% to 40%. But SDD wasn't accepted widely for SDD could induce the development of antibiotic-resistant bacteria, SDD wasn't associated withdecreasing mortality. So someone studied on non-antibiotic oral decontamination in recent years. Dersio et al documented Chlorhexidine Gluconate 0.12%(CHX) oral rinsed twice daily reduced morbidity of YAP by 69% in a randomized, double-blind, placebo-controlled trial, but this trial was limited in patient undergoing heart surgery, and there was no concern for the development of antibiotic-resistant bacteria by using CHX, it only illustrated CHX would not induce antibiotic-resistant of microorganism by literature. There was no similarly report in domestic at present.For system evaluating the effect of oral rinse in preventing VAP, the experiment was randomized,double-blind,placebo-controlled, we studied morbidity of VAP and antibiotic-resistant rate of bacteria in patient undergoing mechanical ventilation with Koutai or aldomycin, which is common oral remover at present.Material And MethodThis study was prospective, randomized, double-blind, placebo-controlled. Randomized the patient inlet to KOUTAI (31), aldomycin (33) and controlled group (31),the patient were dispensed different oral remover to rinse in KOUTAI and aldomycin group, saline was in controlled group. The removers were rigorously applied to tooth, gingival, buccal and tongue for no less 1 minute twice daily. Semi-quantitative-culture and drug sensibility test of Oral secretion and sputum bacterial were performed before rinsed, it repeated again once per two days. Compared the morbidity of total VAP, early VAP and delay VAP and bacteria in antibiotic-resistant at partly among three groups. Exclude the three groups, we choice 10 patients in endotrachealintubation with sucting tube ,rinse oral with KOUTAI, quantitative-culture of secretion under glottis in different time (pre-rinsed, and post-rinsed 2 ,4,6,8,10 hours) to comprehend the nosogenesis of oropharyngeal rinsed.Result1. There was no statistic difference in age, ratio of sex, APACHE II score, danger factors of pneumonia, type of artificial airway (p>0.05). Morbidity of total VAP and early VAP in koutai group(61.29%,35.48%) or in aldomycin group (45.45%,36.36%) were fewer than in controlled group (80%,70%) ,there was no statistical difference between Koutai and aldomycin group .Altuough morbidity of delay VAP in Koutai group (40%) was fewer than in aldomycin and controlled group (62.50%,75%), there was nostatistical difference (P>0.05).2. It has distinction of Gram-Negative bacillus distribution within three groups (p<0.05), but none of Gram-Positive bacillus (p>0.05); the coincidence of bacteria culture was very high (98.91%) between sputum and secretion in oropharyngeal. The first three bacteria of Gram-Negative bacillus in KOUTAI group was E cloacae (39%), klebsiella pneumoniae (24%) and Acinetobacter baumanii (18%); in aldomycin group was Acinetobacter baumanii (30%), Klebsiella pneumoniae (18%) and onion pseudomonas (12%); in controlled group was K...
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