冲洗法在经口气管插管患者口腔护理中的应用

摘要

目的：探讨冲洗法对经口气管插管患者口腔护理的临床疗效。方法采用前瞻性研究方法对汕头大学医学院第一附属医院2011年5月~2014年11月住院治疗的71例经口气管插管危重症患者进行分析，将入院病历号按随机数字表法分为观察组（35例）与对照组（36例）。两组患者均行常规的治疗和护理。观察组患者采用冲洗法行口腔护理，对照组患者行传统的口腔护理方法。观察两组患者的牙菌斑指数、口腔异味、咽拭子细菌培养结果及呼吸机相关性肺炎（VAP）发生情况。结果观察组患者口腔护理操作第1、3、5、7天牙菌斑指数分别为（3.0±0.4）、（2.4±0.2）、（2.1±0.3）、（2.1±0.2）分，对照组分别为（3.1±0.6）、（2.8±0.3）、（2.6±0.1）、（2.4±0.1）分，两组第1天比较差异无统计学意义（P>0.05），第3、5、7天比较差异均有统计学意义（均P<0.05）。观察组患者口臭、咽拭子细菌培养阳性及VAP发生率分别为8.6%、8.6%、5.7%，对照组分别为36.1%、33.3%、27.8%，两组比较差异均有统计学意义（均P<0.05）。结论冲洗法对经口气管插管患者保持口腔清洁有效，降低了口腔感染及VAP并发症的发生，对患者的刺激性小，提高了患者的舒适度，是操作简单、效果可靠的一种方法，值得临床推广应用。%Objective To discuss the clinical effect of irrigation on oral care of patients with oral tracheal intubation. Methods 71 caeses severe patients with oral tracheal intubation of the First Affiliated Hospital of Medical College of Shantou University from May 2011 to November 2014 were analyzed by prospective study method, who were divided into observation group of 35 caeses and control group of 36 caeses according to the random number table. Patients of two groups were given routine treatment and care. Patients in observation group were given irrigation oral care, and pa-tients in control group were given routine oral care. The results of plaque index, bad breath, bacterial culture by throat swabs and the situation of ventilator-associated pneumonia (VAP) of two groups were observed. Results Plaque index of observation group in the first, third, fifth and seventh day were (3.0±0.4), (2.4±0.2), (2.1±0.3), (2.1±0.2) scores, and were (3.1±0.6), (2.8±0.3), (2.6±0.1), (2.4±0.1) scores in control group, there was no significant difference between two groups in the first day (P> 0.05), and there were significant differences in the third, fifth and seventh day (all P<0.05). The occurrence rate of bad breath, positive bacterial culture by throat swabs and VAP were 8.6%, 8.6%, 5.7%, which in control group were 36.1%, 33.3%, 27.8%, there were significant differences between two groups (all P<0.05). Conclusion Irrigation has a good effect to keep oral hygiene in patients with oral tracheal intubation, it can reduce oral infections and complications of VAP, and has a little stimulation, improve the comfort of patients, this method is a sim-ple and effective and worthy of being widely applied in clinic.