机械通气前强化口腔护理在神经重症昏迷患者中的应用

Application of intensive oral care in patients with severe nerve coma before mechanical ventilation

目的:探讨机械通气前强化口腔护理在神经重症昏迷患者中的应用效果。方法:收集2014年10月~2015年10月我院急诊重症监护病房110例行机械通气治疗的神经重症昏迷患者的临床资料,根据口腔护理方法的不同将其等分为观察组和对照组,观察组采用机械通气前强化口腔护理方法,对照组采用常规口腔护理方法,观察并比较两组患者机械通气前、机械通气后24 h、机械通气后72 h咽拭子实验菌落数及呼吸机相关性肺炎发生率、病死率、ICU住院时间、住院费用等指标。结果:观察组患者机械通气后24 h、机械通气后72 h咽拭子实验菌落数均明显低于对照组(P<0.05)。观察组患者呼吸机相关性肺炎发生率明显低于对照组(P<0.05),病死情况与对照组比较差异无统计学意义(P>0.05),ICU住院时间短于对照组(P<0.05),平均住院费用明显低于对照组(P<0.05)。结论:机械通气前强化口腔护理可有效提高口腔清洁度,减少口咽定植菌负荷量,降低呼吸机相关性肺炎的发生率,值得临床推广应用。

Objective：To explore the effect of intensive oral care in patients with severe nerve coma before mechanical ventilation.Methods：The clinical data of 110 patients with severe nerve coma treated by mechanical ventilation were collected from October 2014 to October 2015.According to the different methods of oral care, the patients were divided into observation group and control group.In the observation group, the oral control method was used.The control group was treated with conventional oral care method.The number of colonic swabs and the ventilator were observed and compared between the two groups before and after 24 hours and 72 hours of mechanical ventilation.The pneumonia incidence, mortality, ICU hospital stay, hospital costs and other indicators were compared.Results：The number of colonic swabs in the observation group was significantly lower than that in the control group at 24 hours and 72 hours after mechanical ventilation （P〈0.05）.The incidence of ventilator-associated pneumonia in the observation group was significantly lower than that in the control group （P〈0.05）.There was no significant difference of fatality between the two groups （P〉0.05）.The ICU hospital stay of the observation group was shorter than that of the control group （P〈0.05）.The average hospitalization cost was significantly lower than that of the control group （P〈0.05）.Conclusion：Intensive oral care before mechanical ventilation can effectively improve the oral cleanliness and reduce the load of oropharyngeal colonization bacteria as well as the incidence of ventilator-associated pneumonia.It is worthy of clinical application.