CAJ | 학술논문

目的探讨二维口腔护理对经口气管插管机械通气患者的临床护理效果,以提高护理质量.方法选取ICU 2011年2月至2012年7月经口气管插管机械通气住院患者70例,随机分为观察组和对照组各35例.观察组采用二维口腔护理,即插管前口腔擦洗1次,插管后采取刷洗+冲洗(3次/d)；对照组采用传统口腔擦洗法(3次/d).全部患者在插管前,插管后4,12,24,48 h分别采集咽拭子进行细菌菌落计数,插管后第1天起分别行痰标本及咽拭子(1次/3 d)定性培养,分析两组口咽部细菌变化及呼吸机相关性肺炎(VAP)发生率.结果全部70例患者中,有效病例61例,发生VAP 15例,死亡8例.观察组有效病例31例,发生VAP 4例,死亡3例；对照组有效病例30例,发生VAP 11例,死亡5例.两组VAP发生率差异有统计学意义(x2＝4.643,P＝0.040),两组死亡率差异无统计学意义(x2＝0.654,P＝0.473).两组插管前口腔菌落计数差异无统计学意义(t＝-0.563,P＝0.589),插管后4,12,24,48 h口腔菌落计数差异有统计学意义(t值分别为-1.957,-2.520,-3.560,-2.165；P＜0.05).结论二维口腔护理方法可有效减少经口气管插管患者口咽部细菌生长,降低VAP发生率,与传统方法相比,可明显提高口腔护理质量.
목적 탐토이유구강호리대경구기관삽관궤계통기환자적림상호리효과,이제고호리질량.방법 선취ICU 2011년2월지2012년7월경구기관삽관궤계통기주원환자70례,수궤분위관찰조화대조조각35례.관찰조채용이유구강호리,즉삽관전구강찰세1차,삽관후채취쇄세+충세(3차/d)；대조조채용전통구강찰세법(3차/d).전부환자재삽관전,삽관후4,12,24,48 h분별채집인식자진행세균균락계수,삽관후제1천기분별행담표본급인식자(1차/3 d)정성배양,분석량조구인부세균변화급호흡궤상관성폐염(VAP)발생솔.결과 전부70례환자중,유효병례61례,발생VAP 15례,사망8례.관찰조유효병례31례,발생VAP 4례,사망3례；대조조유효병례30례,발생VAP 11례,사망5례.량조VAP발생솔차이유통계학의의(x2＝4.643,P＝0.040),량조사망솔차이무통계학의의(x2＝0.654,P＝0.473).량조삽관전구강균락계수차이무통계학의의(t＝-0.563,P＝0.589),삽관후4,12,24,48 h구강균락계수차이유통계학의의(t치분별위-1.957,-2.520,-3.560,-2.165；P＜0.05).결론 이유구강호리방법가유효감소경구기관삽관환자구인부세균생장,강저VAP발생솔,여전통방법상비,가명현제고구강호리질량.
Objective To discuss the clinical effect of two-dimensional oral care for patients with mechanical ventilation by orotracheal intubation,and improve the quality of oral care.Methods Seventy inpatients with mechanical ventilation by orotracheal intubation from Feb 2011 to Jul 2012 in ICU were selected and randomly divided into experimental group (n ＝ 35) and control group (n ＝ 35).Experimental group was given two-dimensional oral care (oral swab just one time before intubation,and brush teeth and suction three times a day after intubation).Control group was given traditional oral care three times a day.Throat swab specimens were gathered for bacterial colony counts before intubation,and in 4 h,12 h,24 h,48 h after intubation,respectively.Bacteria quantitative culture was performed in sputum specimens and in throat swab specimens (one time per three days) after intubation.Oropharyngeal bacteria change and the incidence rate of ventilator associated pneumonia (VAP) were observed.Results Among all 70 patients,61 cases were valid,15 cases had VAP,and 8 cases died.In the experimental group,31 were valid,4 had VAP and 3 died,while in the control group,30 were valid,11 had VAP and 5 died.The difference of the incidence rate of VAP was statistically significant (x2 ＝ 4.643,P ＝ 0.040) and the difference of the incidence rate of death was not statistically significant (x2 ＝ 0.654,P ＝ 0.473).The difference of oropharyngeal bacterial colony counts had no statistical significance between two groups before intubation (t ＝-0.563,P ＝ 0.589),while the difference of oropharyngeal bacterial colony counts had statistical significance between groups in 4 h,12 h,24 h,48 h after intubation (t＝1.957,-2.520,-3.560,-2.165,respectively; P＜0.05).Conclusions Two-dimensional oral care can effectively reduce oropharyngeal bacterial colony,and decrease the incidence rate of VAP for patients with mechanical ventilation by orotracheal intubation.Thus it is a better nursing method to improve oral care quality.