预防呼吸机相关性肺炎口腔护理方案效果的Meta分析

Meta analysis on prevention effect of oral care program on ventilator-associated pneumonia

目的评价口腔护理方案在预防呼吸机相关性肺炎(VAP)的效果,为临床应用口腔护理方案预防口腔并发症及VAP的发生提供依据。方法检索2007年3月-2016年3月中国学术期刊全文数据库、万方数据库、维普数据库、中国知网(CNKI)等数据库中所有关于口腔护理方案在预防VAP中应用的相关研究,采用RevMan5.2软件进行统计处理。结果共有随机对照临床试验(RCT)的文献23篇及口腔护理方案应用于气管插管的危重患者2345例纳入研究;分析结果显示:VAP发生率低、口腔异味发生率低、口腔溃疡发生率低、能缩短机械通气时间、能缩短患者住院时间(P<0.01);但对口腔感染率、患者住ICU时间、患者的死亡率差异无统计学意义。结论有效的口腔护理方案是:详细的操作流程、对操作者的要求、床头抬高、气囊管理、口腔护理方法、口腔护理液的选择、每天口腔护理的次数、操作注意事项、恰当镇静等应用对于ICU气管插管的危重患者而言,能够显著降低VAP及口腔并发症的发生,降低机械通气的时间,减少住院时间。

OBJECTIVE To evaluate the effect of oral care program on the prevention of ventilator-associated pneumonia（VAP）,so as to provide a basis for clinical application of oral care program to prevent oral complications and VAP.METHODS Related researches on application of oral care program on the prevention of ventilator associated pneumonia from Mar.2007 to Mar.2016 in Chinese Retrieval Journals Full-text Database,Wanfang Database,VIP Database,CNKI and other database were retrieved,and RevMan5.2software was used for statistical analysis.RESULTS A total of 23 randomized controlled clinical trials（RCT）of 2345 oral care programs used in critical patients with nasotracheal tube were included in the study.The results showed that the low rate of VAP,low incidence of oral odor,low oral ulcer incidence could shorten the time of mechanical ventilation and the hospitalization time.The incidence of oral infection,ICU hospital stays,and the mortality of patients had no significance.CONCLUSION The application of effective oral care programs for critical patients with ICU intubation,including detailed operation process,requirements of the operators,bedside elevation,airbag management,oral care methods,the choice of oral care program,the number of oral care every day,operation cautions and appropriate sedation,can significantly reduce VAP and oral complications,and reduce mechanical ventilation time and hospitalization time..