碱性漱口水对预防血液科发热患者口腔感染的分析

Influence of alkaline mouthwash on oral infections in fever patients of hematology department

目的探讨碱性漱口水对血液科发热患者口腔感染的影响。方法选取2012年1月-2016年12月医院血液科收治的发热患者996例,采用随机数字表法将患者分为观察组和对照组,每组各498例;在进行常规口腔护理宣传教育的基础上,对照组每日晨起、睡前、早、中、晚三餐后采用自制0.9%生理盐水漱口,每次100ml;观察组在每日晨起、睡前、早、中、晚三餐后采用自制5%碳酸氢钠碱性漱口水漱口,每次20ml;干预7d后,统计两组口腔感染率,第一次漱口前、干预结束后,分别由护士对患者口腔清洁度、口腔pH值、口腔气味进行检测,统计两组患者住院时间、抗菌药物费用和其他部位感染率,对发生口腔感染患者,采集口腔分泌物标本进行菌株鉴定。结果对照组和观察组口腔感染率分别为5.22%和2.01%,两组口腔感染率比较差异有统计学意义(P<0.05);干预前,两组口腔清洁度、口腔气味评分和口腔pH值比较差异均无统计学意义;干预后,两组口腔清洁度和口腔气味评分均显著降低(P<0.05),口腔pH值显著上升(P<0.05),且组间比较差异有统计学意义(P<0.05);观察组住院时间、抗菌药物费用均显著低于对照组(P<0.05);观察组其他部位感染率为4.42%,显著低于对照组10.44%(χ~2=4.965,P<0.05);36例口腔感染患者共检出病原菌76株,其中厌氧菌56株占73.68%,需氧菌20株占26.32%,黑色素普氏菌26株占34.21%,是主要厌氧菌类型。结论血液科发热患者应用5%碳酸氢钠碱性漱口水,可有效清洁口腔,改变口腔的酸性环境,改善口腔气味,从而降低口腔感染的发生率。

OBJECTIVE To explore the influence of alkaline mouthwash on oral infections in fever patients of hematology department.METHODS A total of 996 fever patients who were treated in the hematology department from Jan 2012 to Dec 2016 were enrolled in the study and randomly divided into the observation group and the control group,with 498 cases in each group.Based on the publicity and education of routine oral care,the control group was given homemade 0.9%normal saline mouthwash on each day in the morning,before going to bed and after breakfast,lunch and dinner,with 100ml each time;the observation group was given homemade 5%sodium bicarbonate alkaline mouthwash on each day in the morning,before going to bed and after breakfast,lunch and dinner,with 20 ml each time.The incidence of oral infections of the two groups of patients was statistically analyzed after the intervention for 7 days;the oral cleanliness,oral PH value and oral smell were detected by nurses before the first mouthwash and after the intervention;the length of hospital stay,cost of antibiotics and incidence of other sites of infection were statistically analyzed;the oral secretions specimens were collected from the patients with oral infection and were cultured,and the isolated pathogens were identified.RESULTS The incidence rate of oral infections was 5.22%in the control group,2.01%in the observation group,and there was significant difference in the incidence rate of oral infection between the two groups（P〈0.05）.There was no significant difference in the oral cleanliness,score of oral smell,or oral pH value between the two groups before the intervention;the oral cleanliness and score of oral smell of the two groups were significantly reduced after the intervention（P〈0.05）,the oral pH value of the two groups was significantly increased（P〈0.05）.The length of hospital stay of the observation group was significantly shorter than that of the control group,and the cost of antibiotics of the observation group was significantly less than that of the control group（P〈0.05）.The incidence rate of other sites of infection of the observation group was 4.42%,significantly lower than 10.44%of the control group（χ2=4.965,P〈0.05）.Totally 76 strains of pathogens were isolated from the 36 patients with oral infections,of which 73.68%（56 strains）were anaerobic bacteria,26.32%（20 strains）were aerobic bacteria,and 34.21%（26 strains）were Prevotella melaninogenicus.CONCLUSION The 5%sodium bicarbonate alkaline mouthwash can effectively clean the oral cavity,alter the oral acid environment and improve the oral smell so as to reduce the incidence of oral infection.