口腔外科手術患者の細菌汚染低減に及ぼす眼球下生理食塩水灌漑の影響．

Impact of Subglottic Saline Irrigation on Reducing Bacterial Contamination for Oral Surgery Patients.

• Yuki Chogyoji
• Seiji Watanabe

抄録

本研究では、咽頭パックを使用せずに口腔外科手術を行う際の眼球下腔内の細菌汚染の減少に対する100 mLの生理食塩水を用いた眼球下灌漑（SI）の有効性を調査した。喉頭下腔洗浄および灌漑は、喉頭下腔からの脱出を可能にする機能を備えた特殊な気管支（ETT）に設置された吸引管腔を介して実施した。本研究では、九州歯科大学医学部附属病院で全身麻酔下で口腔外科手術を予定されている患者53名を対象に、専用のETTを挿管して口腔外科手術を実施した。挿管直後，手術終了後，SI後の3時点で，眼球下灌流を行い，ETT吸引管腔から検体液を採取し，塗抹・培養細菌検査を行った．咽頭パックなしでの経口手術は、有意に眼球下液中の細菌汚染を増加させ（p < 0.001）、SIは、気管挿管後に見られるレベルと同様に細菌汚染を減少させた（p < 0.001）。100 mLの生理食塩水を用いた眼球下灌漑は、喉パックを使用せずに口腔内外科処置を受けている患者の挿管直後に同様に指摘されたレベルに眼球下空間の細菌負荷を減少させるのに有効であった。

This study investigated the effectiveness of subglottic irrigation (SI) with 100 mL of saline on reducing bacterial contamination in the subglottic space during oral surgery procedures without the use of throat packs. Subglottic lavage and irrigation were performed through the suction lumen located on specialized endotracheal tubes (ETTs) with capabilities of permitting evacuation from the subglottic space. Fifty-three patients who were scheduled for oral surgery procedures under general anesthesia while intubated with specialized ETTs at Kyushu Dental University Hospital were enrolled in this study. Subglottic irrigation was performed, and the sample fluid was collected through the ETT suction lumen for smear and culture bacterial examinations after 3 points in time: immediately after intubation, after completing the surgical procedure, and again after SI. Oral surgery without a throat pack significantly increased bacterial contamination in the subglottic lavage (p < .001), and SI decreased bacterial contamination (p < .001) similarly to levels found after tracheal intubation. Subglottic irrigation with 100 mL of saline was effective in reducing bacterial load in the subglottic space to levels similarly noted immediately after intubation for patients undergoing intraoral surgical procedures without the use of a throat pack.

© 2020 by the American Dental Society of Anesthesiology.