| ObjectiveThe permanent planting bacteria in upper gastrointestinal tract and pharynx oralis being inhaled into lower respiratory tract, which is induced by aspiration and refluxing, is an important cause of hospital-acquired lower respiratory tract infection (HLRTI) in the elderly. This study proposed to evaluate the clinical efficacy and safety of preventing HLRTI in the elderly at high risk by reducing the permanent planting bacteria in the pharynx oralis with oropharyngealdecontamination in combination with gastrointestinal excitomotor for reducing aspiration and refluxing.MethodsWe observed 110 elderly hospitalized patients at high risk of suffering HLRTI in the Second Affiliated Hospital of Medical College of Zhejiang University and the 117th Hospital of Chinese PL A between 2004 Sep. and 2006 Jan, there were 93 male and 17 female patients. This study adopted the design of an open,randomized and blank-controlled clinical trial, the patients were randomized into intervention group and blank-controlled group, each group contained 55 cases. The intervention group used cetylpyridinium chloride gargle for gargling and moshabili plates for oral use, the observation end points were 4 weeks after hospital admission, or discharge from the hospital,HLRTI occurred. We observed the index including occurrence of HLRTI,pharynx swabs culture,sputum culture etc. Statistical analysis was performed with the statistical management software SPSS11.0,with t test to analyse measurement data and x~2 test for the analysis of incidence of HLRTI,migration of the permanent planting bacteria in upper gastrointestinal tract and pharynx oralis as well as the incidence ofincidence of adverse reaction in the two groups, P<0.05 presented that the difference had statistical significance.ResultsThere were 55 patients in each group, and 9 patients were excluded eventually, among which 5 from group A,4 from group B. The differences of basic clinical data, risk factors of infection etc between two groups have no statistical significance,suggesting that the basic data in two groups have good comparability.Patients suffered from HLRTI were 1 case (2.00%) in intervention group and 7 cases(13.73 % )in control group respectively, the difference between two groups has statistical significance (p<0.05) .The pharynx swabs culture were positive in 8 cases of intervention group when they were enrolled, the positive rate is 16.0%(8/50).As intervention time became longer, the trend x test indicated that the upper positive rate decreased gradually(P<0.05),while in the control group it had no significant difference (p>0.05) . x 2cmh test suggested that it had no statistical significance in the two groups in the number of positive strains of the pharynx swabs culture and of permanent planting bacteria (p>0.05), mainly because of the small number of samples.Among 7 patients with HLRTI in the control group, sputum cultures showed that 2 cases were normal flora,4 cases are K.pneumoniae(of which 2 cases were mixed infection with Acinetobacter bauamnnii and Staphylococcus aureus respectively), 1 case was infected with Staphylococcus epidermidis. Among HLRTI patients with positive sputum culture results,the microorganisms cultured from sputum were consistent with the results of the pharynx swabs culture when enrolled in 3 cases infected with K.pneumoniae and 1 case infected with Staphylococcu sepidermidis. There were 7 patients who suffered from adverse effect in the intervention group (12.73%), and 4 patients in the control group (7.27%), and there was no significant difference in the incidence of adverse effect in the two groups (p>0.05 ) .Conclusions(1) It can effectly prevent the elderly patients at high risk suffering hospital-acquired lower respiratory tract infection using cetylpyridinium chloride gargle for gargling and moshabili administrating orally.(2) It's comparatively safe to combine cetylpyridinium chloride gargle and moshabili for the prevention of hospital-acquiredlower respiratory tract infection.(3) It deserves to be extended clinically applying cetylpyridinium chloride gargle in combination with moshabili to prevent hospital-acquired lower respiratory tract infection in the elderly patients at high risk... |
PDF Full Text Request