预防呼吸机相关性肺炎口咽部清洁方法研究

Research of oropharyngeal cleaning methods for ventilator associated pneumonia

目的探讨口咽部清洁方法预防呼吸机相关性肺炎及口腔感染的效果,以降低口腔感染率。方法选取医院2013年1月-2014年1月123例呼吸机辅助呼吸治疗患者,按随机数字表法将其分为3组,每组各41例,A组采用喉镜直视下电动牙刷清洁;B组采用传统口腔擦洗联合口腔冲洗;C组采用传统口腔擦洗,比较3组患者口腔清洁效果。结果经3种不同方法清洁口腔后,A、B、C组口咽部清洁总有效率分别为97.56%、80.49%、65.85%,组间比较差异有统计学意义(P<0.05);A、B、C组牙菌斑指数分别为(1.02±0.02)、(1.62±0.56)、(2.38±0.24)分,组间比较差异均有统计学有意义(F=6.37,P<0.05);A组口腔异味、口腔炎、口腔溃疡和呼吸机相关性肺炎发生率明显低于B、C两组,且B组发生率明显低于C组,比较差异有统计学意义(P<0.05)。结论喉镜直视下电动牙刷清洁口咽部效果更佳,明显改善呼吸机辅助呼吸患者口腔异味和牙菌斑,且在呼吸机相关性肺炎和口腔感染的预防中具有重要的临床价值。

OBJECTIVE To investigate the effect of oropharyngeal cleaning methods for preventing ventilator associated pneumonia and oral infections ,in order to decrease oral infections .METHODS Totally 123 patients receiving ventilation treatment during Jan .2013 to Jan .2014 were randomly divided into three groups by random table method ,41 cases in each group .Group A were given cleaning with electric toothbrush under laryngoscope , group B were given traditional oral cleaning combined with oral rinse ,group C were given traditional oral cleaning . The cleaning effects were compared among the three groups .RESULTS After oropharyngeal cleaning by the three methods ,oropharyngeal cleaning efficiency of groups A ,B ,C was respectively 97 .56% ,80 .49% ,65 .85% ,with inter‐group significance （P〈0 .05） .The dental plaque index of groups A ,B ,C was （1 .02 ± 0 .02） points ,（1 .62 ± 0 .56） points ,（2 .38 ± 0 .24） points ,respectively ,with inter‐group significance （F=6 .37 ,P〈0 .05） .The inci‐dence rates of mouth odor ,stomatitis ,oral ulcer and ventilator associated pneumonia of group A were significantly lower than groups B and C ,and these incidences of group B were significantly lower than group C （P〈0 .05） . CONCLUSION Laryngoscopic electric toothbrush clean has better efficiency for oropharyngeal cleaning ,which can improve mouth odor and dental plaque and has important clinical value in the prevention of ventilator associated pneumonia and oral infections .