Experimental Study On The Effect Of Two Kinds Of Wet Chemical Solution On The Laryngeal Carcinoma Patients With Tracheotomy

Objective:This study aims to explore the influence of 0.9%Nacl solution and 0.45%Nacl solution as airway humidification fluid of laryngeal tracheal incision in patients on casing surface sputum flora distribution, formation of sputum, sputum of third degree,pulmonary infection. To understand the dynamic distribution of bacterial species and strains in the pulmonary infection and the epidemic trend of local bacteria in our hospital,make effective empirical treatment, reduce the production of resistant strains, and provide a reference for clinical selection of reasonable, convenient and effective wet.Methods:Between January to August 2015 in our hospital otolaryngology tracheal incision patients. Inclusion criteria:(1) by pathological diagnosis, diagnosed with laryngeal cancer and underwent laryngectomy and tracheotomy;(2) the preoperative neck skin clean, no pollution;(3) before the surgery no clinical signs of infection and normal temperature;(4) no history of respiratory disease, no history of infection;(5) without requiring mechanical ventilation in the treatment;(6) tube arranged time >15d;(7)volunteered to participate in this study. All selected patients have informed consent.According to the inclusion criteria, 60 patients were divided into two groups according to the order of admission, the experimental group and the control group, 30 cases in each group. Two groups of patients in terms of age, sex, smoking history, diabetes, heart disease, hypertension and other basic diseases, no statistical difference(P>0.05). In the control group, the 0.9%Nacl solution was used to wet the airway, and the experimentalgroup was selected to use 0.45%Nacl solution to wet the airway.Conducting cannula sputum pathogenic examination respectively on two groups of patients with gas resection after 1, 3, 7, 14 d, analysis and study the flora distribution; evaluating airway sputum character; recording sputum scabs, pulmonary infection cases occurred in the two groups.Results:Tracheotomy for laryngeal cancer patients after the continuous sputum bacteriology culture, 0.45%Nacl group cultivate 66 strains of pathogenic bacteria and 0.9%Nacl group cultivate 88 strains of pathogenic bacteria. The two groups of 154 strains of pathogenic bacteria, including 127 strains of G+ bacteria, accounting for 82.5%; 25 strains of Gbacteria, accounting for 16.2%; 2 strains of fungi, accounting for 1.3%. Among all the pathogens isolated, the number of Pseudomonas Aeruginosa was up to 27 strains,accounting for 17.5%. The second is Bauman Acinetobacter 24 strains, accounting for15.6%; again is Klebsiella Pneumoniae 22 strains, accounting for 14.3%. In the isolated G+ bacteria, Corynebacterium and Staphylococcus Aureus was 5.8% and 4.5%,respectively. In addition also cultivated Escherichia Coli, Burkholderia cepacia,Haemophilus parainfluenzae, coagulase negative staphylococcus, Enterococcus faecium,Stenotrophomonas maltophilia, Balcillus proteus mirabilis, Streptococcus pneumoniae,etc. Two groups of patients in postoperative different days under the positive rate of sputum culture and sticky sputum third degree aspect compared had significant difference(P<0.05), suggesting that the solution of 0.45%Nacl can effectively reduce sputum culture positive rate and sputum viscosity, is a good sputum discharged smoothly,increase patient comfort. Two groups in the incidence of sputum and pulmonary infection compared with the difference is not significant(P>0.05).Conclusion:1. According to the laryngeal carcinoma after sputum bacteria dynamic monitoring results, the flexibility in the choice of sensitive antibiotics, help to achieve the besttherapeutic effect and reduce adverse drug reactions and delay the emergence of resistant strains.2. The number of pathogenic bacteria detected in the two groups showed an increasing trend with the increasing of the time of catheter insertion. But can not determine whether the difference between the two kinds of humidification fluid were detected in different time after the operation of strains, further study is required to verify.3. Third and seventh days after operation in 0.45%Nacl group patients in the sputum positive rate and degree of sticky sputum were lower than group 0.9%Nacl.4. 0.45%Nacl solution and 0.9%Nacl solution had no effect on the incidence of sputum scab and the incidence of HAP(14 days after tracheotomy).