危重症患儿机械通气下口腔护理频率的研究

Research on the frequency of oral care in critical children with mechanical ventilation

目的分析气管插管患儿行氯己定口腔护理后不同时间段的口腔状况,选出合理的口腔护理频率。方法选取儿童重症监护室符合纳入标准的63例患儿,运用氯己定口腔护理液冲洗加擦洗的方法进行口腔护理后,分别在口腔护理前和口腔护理后2 h、4 h、6 h、8 h,对患儿口腔采取咽拭子培养。结果对咽拭子结果进行分析,口腔中有致病菌的患儿15例。口腔定植致病菌的菌株数量,口腔护理后2 h最低,口腔护理后8 h最高;细菌菌株数量随时间的增长而增长,呈上升趋势(χ^(2)=1.825,P=0.171);口腔护理后2~6 h上升缓慢,口腔护理后6~8 h为快速上升趋势。口腔内总菌株数量在口腔护理后2 h急剧下降,随着口腔护理结束时间的延长,细菌总菌株数量呈上升趋势(χ^(2)=4.841,P=0.028),增长趋势平稳。结论采用氯己定口腔冲洗加擦洗的方法,每隔6 h进行口腔护理将改善机械通气患儿口腔细菌状况。

Objective To analyze the oral status of children with tracheal intubation in different time periods after oral care with chlorhexidine,and to select the best oral care plan.Methods 63 children who met the included criteria in the Children Intensive Care Unit were selected.The patients received oral care with chlorhexidine by solution washing and scrubbing,pharyngeal swab culture was carried out for the oral cavity before oral care,2 hours,4 hours,6 hours and 8 hours after oral care respectively.Results According to the analysis of swab results,15 cases had pathogenic bacteria in the oral cavity.The number of bacterial strains was lowest 2 hours after oral care,and highest 8 hours after oral care.The number of bacterial strains increased with time(χ^(2)=1.825,P=0.171).The rise was slow 2~6 hours after oral care,and the rise trend became rapid 6~8 hours after oral care.The total number of oral bacteria decreased dramatically 2 hours after oral care.After oral care,the total number of bacterial strains increased with time,showing a stable increasing trend(χ^(2)=4.841,P=0.028).Conclusion Oral care by chlorhexidine solution washing and scrubbing every 6 hours will improve the oral bacteria status of children with mechanical ventilation.