The Effect Of Chlorhexidine For Subglottic Secretions Drainage On Ventilator-associated Pneumonia And Pathogenic Bacteria

Objective:The objective of this study was to discuss the effect of chlorhexidine for subglottic secretions drainage on ventilator-associated pneumonia and pathogenic bacteria.Methods:A prospective randomized controlled trial was used.A total of 120 patients who underwent mechanical ventilation from the emergency ICU and integrated ICU in our hospital from September 2017 to September 2018 were randomly divided into the control group(n?60)and the experimental group(n=60).During the experiment 20 patients satisfying the exclusion criteria were excluded,thus there were 100 patients enrolled in the study,within which 52 patients belonged to the control group and the rest was the experimental group.On the basis of routine care,the control group was washed twice with normal saline every 6 hours and subglottis secretion drainage.The experimental group was rinsed twice with compound chlorhexidine sputum every 6 hours and subglottis secretion drainage.The differences between the two groups for the numbers of VAP occurrence,mortality,MV time,ICU stay time,restricted antibiotic use time;and the numbers of subglottic remnant colonies were all observed and analyzed,after which pathogenic bacteria and drug resistance of patients with VAP were also diagnosed.Result:(1)The incidences of VAP,MV time,ICU stay time,and restricted antibiotic use time within the experimental group were significantly lower than those of the control group(P<0.05).No significant mortality differences were found between the experimental and control groups(P>0.05).(2)There was no significant difference in the number of glottic colonies between the two groups before washing(P>0.05).The number of colony under the glottic retraction in the experimental group was significantly lower than that of the control group after washing(P<0.05).(3)The detection of Gran-negative bacilli in the experimental group was significantly lower than that in the control group(P<0.05);the detection of Gram-positive bacteria and fungi in the two groups was not statistically significant(P>0.05);Gram-negative bacteria is the main pathogens of VAP patient in both groups,with the top 5 figures for bacteria are those of Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and influenza bloodthirsty.The detection rate of Gram-negative bacilli resistant strains in experimental group VAP patients was lower than that in the control group,and the detection rate of Acinetobacter baumannii resistant strains was significantly lower than that in the control group(P<0.05).Conclusion:The use of chlorhexidine for subglottis secretion drainage can significantly reduce the incidence of VAP,MV time,ICU residence time,duration of antibiotic use,and number of colonies in subglottic retentate in mechanically ventilated patients.It can also greatly decrease the detection rate and drug resistance of the main pathogen causing VAP,Gram-negative bacilli,and could be expected as a preventive and therapeutic measure for VAP in clinically,...