國內部分三甲醫院危重疾病患者口腔護理情況調查_《中國循證醫學雜志》

作者：

張綺 , 謝蟪旭 , 何瑤 , 王萍 , 黃瑋 , 彭生誠 , 唐麗潔 ,  史宗道

四川大學華西口腔醫學院（成都?610041）;

關鍵詞：

危重疾病重癥監護室口腔護理問卷調查

DOI：

10.7507/1672-2531.20100472

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目的　了解國內三甲醫院重癥監護室危重疾病患者口腔護理情況，為提高危重疾病患者口腔護理水平提供依據和建議。
方法　采用信訪、向危重病人口腔護理專家咨詢和走訪等調查方式，獲得國內危重疾病患者口腔護理現狀信息。
結果　本次調查共發放調查問卷184份，回收有效問卷79份，有效回收率42.93%。所有回復者均認為口腔護理對于危重疾病患者很重要，有98.7%的重癥監護室采取了不同的方式進行護理前評估，包括檢查口腔基本情況及口腔分泌物提取，評估實施者主要為床旁責任護士（63.3%）。目前使用最多的口腔護理方式為棉球擦洗法（62.5%），護理頻率每日2～3次，每次平均時間9.1±5.1?min，主要使用的口腔護理液有生理鹽水（76.0%）、碳酸氫鈉（22.8%）、呋喃西林（13.9%）、雙氧水（13.9%）等。
結論　目前國內口腔護理水平相差較大，應加強針對循證口腔護理的培訓，有必要建立危重疾病患者口腔護理的全國統一規范。

引用本文： 張綺,謝蟪旭,何瑤,王萍,黃瑋,彭生誠,唐麗潔,史宗道. 國內部分三甲醫院危重疾病患者口腔護理情況調查. 中國循證醫學雜志, 2010, 10(6): 665-669. doi: 10.7507/1672-2531.20100472 復制

1.	Heo SM, Haase EM, Lesse AJ, et al. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis, 2008, 47(12): 1562-1570.
2.	Nardi G, Di Silvestre AD, De Monte A, et al. Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin. Eur J Emerg Med, 2001, 8(3): 203-204.
3.	El-Solh AA, Pietrantoni C, Bhat A, et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest, 2004, 126(5): 1575-1582.
4.	Fagon JY, Chastre J, Hance AJ, et al. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med, 1993, 94(3): 281-288.
5.	Apostolopoulou E, Bakakos P, Katostaras T, et al. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens. Res Care, 2003, 48(7): 681-688.
6.	Pugin J, Auckenthaler R, Lew DP, et al. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA, 1991, 265(20): 2704-2710.
7.	Loesche WJ. Association of the oral flora with important medical diseases. Curr Opin Periodontol, 1997, 4: 21-28.
8.	Goldie SJ, Kiernan-Tridle L, Torres C, et al. Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes. Am J Kidney Dis, 1996, 28(1): 86-91.
9.	Mori H, Hirasawa H, Oda S, et al. Oral Care educes incidence of Ventilator-Associated Pneumonia in ICU Populations. Intensive Care Med, 2006, 32(2): 230-236.
10.	史宗道, 余京儒, 羅勇, 等. 口腔護理作用的系統評價. 中國循證醫學雜志, 2004, 4(12): 837-846, 858.
11.	陳玉霞, 李旭茹, 劉素貞, 等. ICU人工氣道患者呼吸道致病菌分布的調查及護理. 熱帶醫學雜志, 2004, 4(5): 631-632.
12.	Cook DJ, Walter SD, Cook RJ. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med, 1998, 129(6): 433-440.
13.	謝蟪旭, 王萍, 張綺, 等. 危重疾病患者口腔護理研究進展. 中華醫學雜志, 2010, 90(16): 1148-1150.
14.	de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med, 2009, 360(1): 20-31.
15.	Arabi Y, Al-Shirawi N, Memish Z. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis, 2008, 12(5): 505-512.
16.	楊琴. 口腔護理. 見: 尚少梅, 主編. 護理學基礎. 北京: 北京大學醫學出版社, 2008: 240-244.
17.	Jones H, Newton JT, Bower EJ. A survey of the oral care practices of intensive care nurses. Intensive Crit Care Nurs, 2004, 20(2): 69-76.
18.	McNeill H. Biting back at poor oral hygiene. Intensive Crit Care Nurs, 2000, 16(6): 367-372.
19.	Ross A, Crumpler J. The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Intensive Cri Care Nurs, 2007, 23(3): 132-136.
20.	Binkley C, Furr LA, Carrico R, et al. Survey of oral care practices in US intensive care units. Am J Infect Control, 2004, 32(3): 161-169.
21.	Pobo A, Lisboa T, Rodriguez A, et al. A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest, 2009, 136(2): 433-439.
22.	Koeman M, van der Ven A, Hak E, et al. Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia. Am J Resp Cri Care Med, 2006, 173(12): 1348-1355.
23.	Tantipong H, Morkchareonpong C, Jaiyindee S, et al. Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol, 2008, 29(2): 131-136.
24.	Seguin P, Tanguy M, Laviolle B, et al. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma. Cri Care Med, 2006, 34(5): 1514-1519.
25.	Sierra R, Macor A, Agbaht K. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med, 2007, 33: 1066-1070.
26.	尹培剛, 黃勇, 吳琨, 等. 首次全國ICU現狀調查分析. 中國危重病急救醫學, 2002, 14(3): 166-168.

1. Heo SM, Haase EM, Lesse AJ, et al. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis, 2008, 47(12): 1562-1570.
2. Nardi G, Di Silvestre AD, De Monte A, et al. Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin. Eur J Emerg Med, 2001, 8(3): 203-204.
3. El-Solh AA, Pietrantoni C, Bhat A, et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest, 2004, 126(5): 1575-1582.
4. Fagon JY, Chastre J, Hance AJ, et al. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med, 1993, 94(3): 281-288.
5. Apostolopoulou E, Bakakos P, Katostaras T, et al. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens. Res Care, 2003, 48(7): 681-688.
6. Pugin J, Auckenthaler R, Lew DP, et al. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA, 1991, 265(20): 2704-2710.
7. Loesche WJ. Association of the oral flora with important medical diseases. Curr Opin Periodontol, 1997, 4: 21-28.
8. Goldie SJ, Kiernan-Tridle L, Torres C, et al. Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes. Am J Kidney Dis, 1996, 28(1): 86-91.
9. Mori H, Hirasawa H, Oda S, et al. Oral Care educes incidence of Ventilator-Associated Pneumonia in ICU Populations. Intensive Care Med, 2006, 32(2): 230-236.
10. 史宗道, 余京儒, 羅勇, 等. 口腔護理作用的系統評價. 中國循證醫學雜志, 2004, 4(12): 837-846, 858.
11. 陳玉霞, 李旭茹, 劉素貞, 等. ICU人工氣道患者呼吸道致病菌分布的調查及護理. 熱帶醫學雜志, 2004, 4(5): 631-632.
12. Cook DJ, Walter SD, Cook RJ. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med, 1998, 129(6): 433-440.
13. 謝蟪旭, 王萍, 張綺, 等. 危重疾病患者口腔護理研究進展. 中華醫學雜志, 2010, 90(16): 1148-1150.
14. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med, 2009, 360(1): 20-31.
15. Arabi Y, Al-Shirawi N, Memish Z. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis, 2008, 12(5): 505-512.
16. 楊琴. 口腔護理. 見: 尚少梅, 主編. 護理學基礎. 北京: 北京大學醫學出版社, 2008: 240-244.
17. Jones H, Newton JT, Bower EJ. A survey of the oral care practices of intensive care nurses. Intensive Crit Care Nurs, 2004, 20(2): 69-76.
18. McNeill H. Biting back at poor oral hygiene. Intensive Crit Care Nurs, 2000, 16(6): 367-372.
19. Ross A, Crumpler J. The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Intensive Cri Care Nurs, 2007, 23(3): 132-136.
20. Binkley C, Furr LA, Carrico R, et al. Survey of oral care practices in US intensive care units. Am J Infect Control, 2004, 32(3): 161-169.
21. Pobo A, Lisboa T, Rodriguez A, et al. A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest, 2009, 136(2): 433-439.
22. Koeman M, van der Ven A, Hak E, et al. Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia. Am J Resp Cri Care Med, 2006, 173(12): 1348-1355.
23. Tantipong H, Morkchareonpong C, Jaiyindee S, et al. Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol, 2008, 29(2): 131-136.
24. Seguin P, Tanguy M, Laviolle B, et al. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma. Cri Care Med, 2006, 34(5): 1514-1519.
25. Sierra R, Macor A, Agbaht K. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med, 2007, 33: 1066-1070.
26. 尹培剛, 黃勇, 吳琨, 等. 首次全國ICU現狀調查分析. 中國危重病急救醫學, 2002, 14(3): 166-168.

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《中國循證醫學雜志》

國內部分三甲醫院危重疾病患者口腔護理情況調查

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