基于Beck口腔评分的综合口腔护理干预体系在气管插管病人中的应用

摘要

Objective To explore the effects of comprehensive oral care intervention system based on Beck Oral Assessment Score (BOAS) in oral care of orotracheal intubation patients. Methods Comprehensive oral care intervention system based on BOAS was implemented in 33 orotracheal intubation patients who met the inclusion criteria from October 2012 to February 2014. The system includes BOAS, the frequency of oral care (based on BOAS, twice to 4 times per day), systematic oral care and the scoring after intervention. After five-day implementation, incidence of oral odor, bacteria count of oropharyngeal bacteria culture and BOAS were compared at the first, the third and the fifth day. Results There was lower incidence of oral odor, bacteria count of oropharyngeal bacteria culture and BOAS in three days (P<0.05) and the incidence of ventilator associated pneumonia (VAP) was 6.1%. Conclusion Comprehensive oral care intervention system based on BOAS can standardize oral care procedure, reduce the incidence of oral odor, the bacterial colonization in the oropharynx and VAP.%目的：评价以Beck口腔评分为指导的综合性口腔护理干预体系在气管插管病人口腔护理中的运用效果，为建立规范化的口腔护理协议提供循证依据。方法2012年10月-2014年2月对进入我科行经口气管插管机械通气治疗的、符合纳入标准的33例病人，使用基于Beck口腔评分的综合性口腔护理干预体系进行口腔护理。综合性的口腔护理干预体系包含了：Beck口腔评分，由评分确定系统性口腔护理的频次，系统性口腔护理，以及干预后的再次评分。根据评分情况给予2次/d至1次/4h的口腔护理，采用综合气道吸引、负压吸引式牙刷刷牙、口腔冲洗、口腔擦拭、口腔湿润及氯己定漱口液共同作用的系统性口腔护理程序进行口腔护理。观察期为5 d。观察病人第1天、第3天、第5天口腔护理前口腔异味发生率、口咽部细菌培养结果、Beck口腔评分及呼吸机相关性肺炎发生率。结果3个测量时间点口腔异味发生率、口咽部细菌培养致病菌菌株数及 Beck口腔评分差异有统计学意义（P<0.05），各个指标呈现下降趋势，呼吸机相关性肺炎发生率6.1%。结论以Beck口腔评分为指导的综合性护理干预体系对经口气管插管病人进行口腔护理，能减少口腔异味的发生，减少口咽部细菌定植、改善口腔健康状况，并降低呼吸机相关性肺炎的发生率。