不同频次中药口腔护理改善经口气管插管患者口腔状态效果的比较

Evaluation of oral care frequency using Traditional Chinese Medicine solution in mechanically ventilated patients with orotracheal intubation

目的:观察不同频次中药口腔护理对改善经口气管插管患者口腔功能状态的效果,为危重患者中药口腔护理提供临床实践依据。方法:选取2014年10月至2017年4月入住我院重症监护病房的经口气管插管机械通气患者共计171例为研究对象,随机分为A、B、C、D组,其中A、B、C组是实验组,采用中药口腔护理液进行口腔护理,口腔护理频次分别为1次/日(A组)、2次/日(B组)、3次/日(C组),D组是对照组,采用生理盐水进行2次/日的常规口腔护理;研究周期为7天,用改良Beck口腔评估工具,咽拭子检测等评价护理前后患者口腔功能状态。结果:各组第7日的Beck评分与首次口腔护理前相比,分值均有下降(P<0.05);实验组(A、B、C组)均分别与对照组有统计学差异(P<0.05),A、B、C组组间比较,结果均无统计学差异(P>0.05);4组患者第3日、第4日及第7日的咽拭子微生物半定量检测有统计学差异(P<0.05),各组间比较,实验组优于对照组(P<0.0083),但3个实验组统计结果未现组间差异(P>0.0083)。结论:中药口腔护理液可有效改善经口气管插管患者口腔功能状态,减少口腔微生物数量,但不同频次中药口腔护理在改善口腔功能状态及抑菌效果方面没有差异,提示为经口气管插管患者进行中药口腔护理时,可以考虑使用合理频次,在保证患者口腔护理质量的基础上节约人力及物力成本。

Objective: To explore an effective, safe and appropriate oral care frequency in improving oral health among mechanically ventilated patients with orotracheal intubation using Traditional Chinese Medicine (TCM) oral care solution, and to provide clinical practice basis for oral care using TCM oral solutino among critical patients. Methods: A total of 171 mechanically ventilated patients admitted to ICU from October 2014 to April 2017 were enrolled for the current study. Patients were randomly divided into four groups (Group A, B, C and D) in which A through C were the intervention groups. In the intervention groups, TCM oral solution was used for oral care with different frequencies: 1 time/day (Group A), 2 times/ day (Group B) and 3 times/day (Group C). Group D was the control group, in which patients received routine oral care twice a day with normal saline. The length of intervention was 7 days, and the patient's oral health was evaluated using the modified Beck oral evaluation tool and pharyngeal swab test at baseline and after the intervention was completed. Results: The mean Beck oral scores at the 7th day in each intervention group all decreased significantly compared with the scores at baseline (P<0.05). Multiple between group comparisons showed that there were statistically significant differences between each of the three intervention groups (Group A, Group B, and Group C) and the control group (P<0.05) on the Beck oral score, however, no significant differences exist among the three intervention groups that used TCM oral care solution (P>0.05). The semiquantitative detection of oral microorganism through pharyngeal swab tests showed statistically significant differences on number of oral microorganisms on day 3, 4 and 7 among four groups (P<0.05). The between group comparisons showed that the three intervention groups that used TCM oral care solution were superior to the control group in reducing the number of oral microorganisms (P<0.0083), but no statistical differences were detected among the three intervention groups (P>0.0083). Conclusion: Using TCM solution in oral care can effectively improve oral health of mechanically ventilated patients with orotracheal intubation and reduce the number of oral microorganisms. The results of this study showed that more frequent oral care using TCM oral solution among these patients did not necessarily produce better effect in improving oral health. In terms of reducing the number of oral microorganism, there are no differences whether the oral care performed once a day, twice a day or three times a day. This suggests that oral health can be achieved by reasonablea frequency oral care using TCM oral solution among mechanically ventilated patients.