The Study Of Antibacterial Effect With Chlorhexidine Oropharyngeal Care Solution In Mechanically Ventilated Patients

ObjectiveWe developed the Meta-analysis of clinical trails about the influence of chlorhexidine solution for oral care on the incidence of ventilator-associated pneumonia (VAP).The research studyed on the antibacterial activity of0.12%chlorhexidine solution for oralcare in mechanically ventilation patients therefore to confirm the influence of chlorhexidine solution on the occurrence of VAP.Methods1.Meta-analysis we had searched domestic and international literature, the key words include ventilator-associated pneumonia,ventilators,mechanical,oral hygiene,chlorhexidine,prevention,critical care,intensive care units,mechanical ventilation,chlorhexidine solution,oral care.followed by assessing the effect of the chlorhexidine solution on the incidence of VAP in a rigorous way one by one。Using statistical analysis (Meta-Analysis) provided by the Cochrane Collaboration’s RevMan4.2software package, count the quantitative sum and draw general conclusions.2.clinical study40ICU patients with respiratory failures were enrolled in this study from July to September in2010in the third general hospital, who were treated with mechanical ventilation under artificial intubation. As self-control study of patients, saline solution and chlorhexidine solution were applied to the same patient respectively at different time for oral care. Specimens were collected and inspected immediately, and colonies calculated in two hours before and after oral care. Halitosis, nausea, and dry mouth level were evaluated after oral care. The data was analyzed by SPSS13.0statistical software.Results1.Meta-analysis Using key words we found9literatures according to our inclusion criteria. All of literatures are international literatures that included a total of1892patients. The trial group use chlorhexidine solution for oral care in which there are931patients,the control group use placebo,NaHCO3or phenolic mixture or0.01%KMNO4solution in961patients.Seven in nine literatures reported the incidence of VAP and the effectiveness of chlorhexidine solution.There are no significant Statistical heterogeneity, in all literatures,I2=30.9%(P=0.17)。So adopting systematic, fixed effect model for Meta-analysis, the outcome shows there are8.49%(79/931) patients whom has VAP in trail group,control group12.28%(118/961) patients.The OR value is0.62(95%CI0.45～0.84) that turns out chlorhexidine solution can reduce the incidence of VAP, P<0.05.2.clinical study Comparing bacterial colonies before and after oral care, both P<0.05,there were statistically significant differences using saline or chlorhexidine solutions, therefore oral care with saline or chlorhexidine solution could be effective for reducing bacterial colonies in the mouth. Before oral care, bacterial colonies compared, both P>0.05, there was no statistical difference;after oral care with saline and chlorhexidine solutions, bacterial colonies compared, P<0.05, there was statistically significant difference, which it could be considered that bacterial colonies were reduced more by chlorhexidine solution than saline solution. Compared indicators of halitosis, nausea, and dry mouth level, all P<0.05, there were statistically significant differences, which it could be considered that the effect of chlorhexidine solution in oral care is better than saline solution.Conclusion1.Oral care can reduce the bacterial colonies in mouth that turns out the effectiveness. So we should emphasis on the operation of oral care in mechanically ventilation patients.2.Chlorhexidine solution for oral care can decrease the counts of bacterial colonies in mouth significantly,and inhibit quantity of bacteria effectively,improving the effect of oral care and reducing the moving and colonization of microbes in mouth and lung.3.Chlorhexidine solution for oral care has a good effect on reducing the incidence of VAP.