| Background The intensive care unit(ICU)is a place for centralized treatment of critically ill patients,with frequent invasive operations,and it is inevitable to use a variety of antibiotics and immunosuppressants during treatment,thereby reducing the patient’s resistance and immune function,and creating favorable conditions for the occurrence of nosocomial infections.The incidence of ventilator associated pneumonia(VAP)is also increasing year by year with the widespread use of ventilators in the treatment of critically ill patients.Tracheal intubation not only destroys the barrier function of the respiratory mucosa against pathogenic bacteria,but also makes it difficult to keep the oropharynx clean,thus becoming a breeding ground for bacterial colonization and reproduction.Despite the continuous upgrading of antibiotics,the source of infection is difficult to control effectively,so that the pathogenic bacteria are protected and gradually become less sensitive to antibiotics,and even form multi-drug resistant bacteria(MDR).This causes secretions from the oropharynx rich in multi-drug resistant pathogens to flow into the lower respiratory tract along the narrow gap around the tracheal tube,becoming a major source of MDR-VAP pathogens.Therefore,the use of safe and effective bactericidal agents to eliminate bacterial colonization of the oropharynx is a key component of the prevention and treatment of VAP.At present,there are few clinical studies on antiseptic agents used to eliminate bacterial colonization in the oropharynx.The "compound chlorhexidine gargle" is a commonly used antiseptic agent for oropharyngeal cleaning and has been clinically effective,but its high irritation,short duration of action and even induced bacterial resistance to carbapenem antibiotics are quite worrying.It has been confirmed that some Chinese herbal medicines have powerful bactericidal effects and have played an important role in the prevention,control and rescue of this new coronavirus infection.In this study,we selected Chinese herbal preparations and 0.12% compound chlorhexidine gargle against saline to observe the bactericidal and antibacterial effects on oropharyngeal colonized bacteria in patients with invasive mechanical ventilation,and the prevention and treatment of VAP.In order to provide a safe,effective,inexpensive and environmentally friendly new formulation for clinical use,and to obtain a more ideal method for the prevention and treatment of multi-drug resistant bacterial infections.This will reduce the cost of hospitalization and improve clinical outcomes.Objective To study the effect of herbal preparations on bacterial expectoration in the oropharynx of patients with invasive mechanical ventilation,reduce the detection rate of multi-drug resistant bacteria in patients,shorten the duration of mechanical ventilation and ICU hospitalization time,reduce the VAP morbidity and 28-day mortality.Methods Critically ill patients admitted to the ICU of the two affiliated hospitals of Qingdao University(South City Campus and West Coast Campus)from March 2019 to September 2020 with invasive mechanical ventilation and expected to last longer than 4 days were selected.All study subjects were given conventional treatment,enteral nutrition via nasogastric tube and conventional care,and randomly divided into groups A,B and C.Group A used 0.12% compound chlorhexidine gargle solution,group B used Chinese medicine preparation(composition of thymol compound),and group C used saline as the control group.The same oropharyngeal cleaning method was used in different subgroups,and was performed every 6 hours.Patients with mechanical ventilation duration<48 h or mechanical ventilation start to study stop <9 d were automatically excluded from the study.The bacterial colony counts of subpharyngeal secretions,the detection rate of multi-drug resistant bacteria in VAP patients,the duration of mechanical ventilation,the duration of ICU stay and the28-day mortality rate were compared among the three groups.Rrsults A total of 104 patients were included in the final study,including 35 in Group A,32 in Group B and 37 in Group C.The subglottic secretions were aspirated for bacterial culture by subglottic suction tube via tracheal intubation,and after calculating the colony count,it was found that the mean colony counts on days 3,6 and 9 were lower in groups A and B than in group C(P<0.05),and lower in group B than in group A(P<0.05).The incidence of VAP in groups A and B was significantly lower than that in group C(P<0.05),and the detection rate of multi-drug resistant bacteria was lower in group B(P<0.05).The duration of mechanical ventilation and ICU stay were less in groups A and B than in group C(P<0.05),and less in group B than in group A(P<0.05).There was no significant difference in 28-day mortality rate among the three groups(P>0.05),and no local tissue injury of oropharyngeal soft tissue and mucosa was found in both groups A and B.Conclusion Both the herbal preparation and the compound chlorhexidine gargle had the effect of reducing the local colonization of bacteria,and there was no local tissue damage in the upper respiratory tract.The bactericidal effect of the herbal preparation was stronger and longer lasting,thus reducing the occurrence of ventilator-associated pneumonia caused by drug-resistant bacteria.It is a new safe,effective,inexpensive and well-tolerated bactericidal agent.It has high clinical application and promotion value. |
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