冲洗和擦拭对ICU气管插管病人口腔菌群水平的影响分析  

Analysis of influence of irrigation and wiping on oral microflora level of patients with tracheal intubation in ICU

作　　者：邢斌瑜 申存毅[1] 林婷[1] 谭文君[1] XING Binyu;SHEN Cunyi;LIN Ting;TAN Wenjun(Department of Critical Care Surgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710000,China)

机构地区：[1]西安交通大学第一附属医院外科重症医学科,陕西西安710000

出　　处：《安徽医药》2024年第12期2367-2371,共5页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省重点研发计划项目(2023-YBSF-421)。

摘　　要：目的探讨冲洗和擦拭对重症监护病房(ICU)气管插管病人口腔菌群水平的影响。方法选取2021年1月至2022年12月西安交通大学第一附属医院ICU行气管插管病人180例,均予以口腔护理,按照随机数字表法分为擦拭组60例,采用0.9%氯化钠溶液进行常规口腔擦拭,每天3次;冲洗组60例,予以0.9%氯化钠溶液口腔冲洗,每天3次;联合组60例,插管前口腔擦拭,插管后采取口腔擦拭联合冲洗方式,每天3次。对比三组机械通气时间、ICU住院时间、口腔菌群水平、口腔卫生情况。采用Kaplan-Meier曲线分析三组呼吸机相关性肺炎(VAP)发生情况。结果三组机械通气、ICU住院时间对比差异有统计学意义(P<0.05),联合组机械通气时间、ICU住院时间较冲洗组和擦拭组缩短(P<0.017);三组插管后8 h、16 h、24 h口腔护理后口腔菌群水平对比差异有统计学意义(P<0.05),联合组插管后8 h、16 h[(5.02±0.67)lgCFU/g比(5.39±0.68)lgCFU/g、(5.41±0.66)lgCFU/g]、24 h口腔护理后菌落计数较冲洗组和擦拭组少(P<0.017);三组插管后第7天口腔清洁度及菌斑指数评分对比差异有统计学意义(P<0.05),联合组插管后第7天口腔清洁度及菌斑指数评分较冲洗组和擦拭组低(P<0.017);Kaplan-Meier曲线分析显示三组VAP发生率对比差异有统计学意义(P<0.05),联合组VAP发生率较冲洗组和擦拭组低(P<0.017)。结论冲洗联合擦拭口腔护理方式有效改善ICU气管插管病人口腔菌群和口腔卫生情况,降低VAP发生率,缩短机械通气时间和住院时间。Objective To investigate the effects of irrigation and wiping on oral microflora before and after endotracheal intubation in intensive care unit(ICU).Methods A total of 180 patients receiving tracheal intubation in the ICU of the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to December 2022 were selected,and all of them were given oral care.According to random number table method,60 cases were divided into wiping group.Normal saline was used for routine oral wiping,3 times a day.In the irrigation group,60 cases were given oral irrigation with normal saline,3 times a day;In the combined group,60 cases were given oral wiping before intubation and oral wiping combined with irrigation after intubation,3 times a day.The mechanical ventilation time,ICU stay time,oral flora level and oral hygiene of the three groups were compared.Kaplan-Meier curve was used to analyze the incidence of ventilators associated pneumonia(VAP)in the three groups.Results The mechanical ventilation time and ICU stay time of the three groups were significantly different(P<0.05),and the mechanical ventilation time and ICU stay time of the combined group were shorter than those of the washing group and the wiping group(P<0.017).There were statistically significant differences in the level of oral flora after 8 h,16 h and 24 h oral care among the three groups(P<0.05),and the number of bacterial colonies in the combined group after 8 h,16 h and 24 h oral care was lower than that in the rinsing and wiping groups(P<0.017).There were statistically significant differences in oral cleanliness and plaque index scores on 7 d after intubation among the three groups(P<0.05),and the oral cleanliness and plaque index scores on 7 d after intubation in the combined group were lower than those in the rinsing and wiping groups(P<0.017).Kaplan-Meier curve analysis showed that there was a statistically significant difference in the incidence of VAP among the three groups(P<0.05),and the incidence of VAP in the combined group was lower th

关 键 词：口腔护理 插管法 气管内 呼吸机相关性肺炎 重症监护病房 口腔菌群 口腔擦拭 口腔冲洗 

分 类 号：R472[医药卫生—护理学]