ICU气管插管老年患者口腔黏膜压力性损伤特征及其影响因素分析  

Characteristics and influencing factors of oral mucosal pressure injury in ICU elderly patients with tracheal intubation in ICU

作　　者：王宝芹 蒋学娟[1] 史广玲[1] 李北 WANG Bao-qin;JIANG Xue-juan;SHI Guang-ling;LI Bei(Department of Critical Care Medicine,Brain Hospital Affiliated to Nanjing Medical University.Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院重症医学科,210029 [2]江苏省第二中医院口腔科,南京210017

出　　处：《中华老年口腔医学杂志》2024年第4期200-204,229,共6页Chinese Journal of Geriatric Dentistry

基　　金：2023年医疗质量(循证)管理研究项目(YLZLXZ23G010)。

摘　　要：目的探究重症监护病房(ICU)气管插管老年患者口腔黏膜压力性损伤(Presusse Injury,PI)特征,并分析其影响因素。方法选取2019年1月至2023年12月南京医科大学附属脑科医院收治的197例ICU经口气管插管老年患者为研究对象,统计口腔黏膜PI发生情况并分析其临床特征,采集口腔分泌物样本计算口腔细菌计数,采用多因素Logistic回归分析口腔黏膜压力性损伤的影响因素。结果197例ICU气管插管患者中有29例发生口腔黏膜PI,发生率为14.72%;口腔黏膜PI发现时间在气管插管留置后的36~302 h,中位发现时间为留置插管后103 h;损伤共43处,发生于下唇处较多,占37.21%(16/43),其次在腭,占比20.93%(9/43);PI分期以2期为主,占比51.16%;发生口腔黏膜PI患者的气管插管留置时间、抗凝药物使用率、口腔铜绿假单胞菌计数均高于未发生口腔黏膜PI患者,格拉斯哥昏迷评分、血清白蛋白水平均低于未发生口腔黏膜PI患者(P<0.05);长时间留置气管插管(OR=2.321)、使用抗凝药物(OR=1.943)、低水平GCS评分(OR=2.901)、低水平血清白蛋白(OR=3.108)、高水平口腔铜绿假单胞菌计数(OR=2.649)均为经口气管插管患者口腔黏膜PI发生的危险因素(P<0.05)。结论ICU气管插管老年患者口腔黏膜PI发生率较高,其发生与气管插管留置时间、抗凝药物、GCS评分、血清白蛋白水平及口腔铜绿假单胞菌等多种因素有关,对这些危险因素进行早期防治可能有助于降低ICU气管插管患者口腔黏膜PI发生风险。Objective To explore the characteristics of oral mucosal pressure injury(PI)in elderly patients with tracheal intubation in intensive care unit(ICU)and analyze its influencing factors.Methods 197 ICU elderly patients with oral tracheal intubation in Brain Hospital Affiliated to Nanjing Medical University were selected as the research subjects from January 2019 to December 2023.The occurrence of oral mucosal PI was counted analyzed and its clinical characteristics were analyzed.Oral mucus samples were collected to calculate the oral bacterial count.The influencing factors of oral mucosal pressure injury were analyzed by multi-factor Logistic regression.Results Among the 197 ICU patients with tracheal intubation,29 cases had occurred oral mucosal PI,with an incidence rate of 14.72%.The occurrence time of oral mucosal PI was 36-302 h after tracheal intubation placement,and the median occurrence time was 103 h after intubation placement.There were 43 injuries,most of which occurred in the lower lip[37.21%(16/43)],followed by the palate[20.93%(9/43)].PI staging was mainly stage 2,accounting for 51.16%.The tracheal intubation placement time,anticoagulant use rate and oral Pseudomonas aeruginosa count in patients with oral mucosa PI were higher than those of patients without oral mucosal PI while the Glasgow Coma Score(GCS)and serum albumin level were lower than those of patients without oral mucosal PI(P<0.05).Long-term indwelling tracheal intubation(OR=2.321),anticoagulant use(OR=1.943),low GCS score(OR=2.901),low serum albumin(OR=3.108)and high count of oral Pseudomonas aeruginosa(OR=2.649)were all risk factors for oral mucosal PI in patients with oral tracheal intubation(P<0.05).Conclusion The incidence rate of oral mucosal PI in ICU elderly patients with tracheal intubation is higher,and its occurrence is related to a variety of factors such as tracheal intubation placement time,anticoagulant drug,GCS score,serum albumin level and oral Pseudomonas aeruginosa count.Early prevention and treatment of these risk factor

关 键 词：重症监护病房 气管插管 口腔黏膜 压力性损伤 影响因素 

分 类 号：R787[医药卫生—口腔医学]