不同护理方法预防经口气管插管病人口腔感染的效果观察

[目的]探讨经口气管插管机械通气病人口腔护理最为有效的护理形式、频次和护理液,找出影响口咽部细菌定植及发生口腔溃疡、口臭和出血的主要影响因素,为经口气管插管病人口腔护理提供针对性的措施。[方法]采用析因设计的方法,将27例机械通气病人进行交叉分组,按照由不同口腔护理形式、护理频次和护理液的搭配进行口腔护理,观察比较口咽部的细菌定植数量及口腔溃疡、口臭和出血的发生率。[结果]护理方式（A 因素）、护理频次（B 因素）以及护理液（C 因素）两两之间的一级交互作用差异无统计学意义,各因素之间均无交互作用；护理频次对口腔细菌定植的主效应差异有统计学意义（P=0.018）,3组间两两比较,Tid 组与Q6 h组间差异有统计学意义（P=0.048）,Q6h 组较 Tid 组和 Bid 组细菌定植数量减少明显；护理液对口腔细菌定植的主效应差异有统计学意义（P=0.020）,3组间两两比较,生理盐水组与益口含漱液组间差异有统计学意义（P=0.008）,益口含漱液组较生理盐水组细菌定植数量减少明显。在预防和治疗口腔溃疡方面,益口含漱液组对预防治疗口腔溃疡的有效率（55.6%）高于西帕依固龈液组（11.1%）；在改善口臭和出血方面,西帕依固龈液组优于益口含漱液组及生理盐水组。[结论]对气管插管机械通气病人采用先冲洗后擦洗法配合益口漱口液进行 Q6 h 的口腔护理是较为有效的护理方法。

Observation on effect of different nursing methods for prevention of oral infection in patients with oral tracheal intubation

Obj ective：To probe into the most effective care form,frequency and care solutions in oral care of patients with oral tracheal intubation,and find out the main factors influencing oropharyngeal bacterial colonization, mouth ulceration,halitosis and oral hemorrhage,so as to provide the targeted measures for oral care of patients with oral tracheal intubation.Methods：The method of factorial design was used,and the 27 patients with mechanical ventilation received cross grouping,and they received oral care with differ-ent oral care forms,nursing frequency and care solution interactively.Then to observe and compare the incidences of quantity of bacterial colonization, mouth ulceration,halitosis and oral hemorrhage.Results：There was no statistically significant differences in A first order interaction between the oral care form （factor A）and the frequency （factor B）;there was no statistically significant differences in A first order interaction between the oral care form （factor A）and the care solution （factor C）;there was no statistically significant differences in A first order interaction between the frequency （factor B）and the care solution（factor C）.There was no interaction among these factors.There was statistically significant difference in main effect of oral care frequency for bacterial colonization （P=0.018）,the comparison between three groups of two two,there was statistically significant difference between group Q6h and group Tid （P=0.048）,the number of bacterial colo-nization in Q6h group was reduced than that in Tid group significantly.There was statistically significant difference in main effect of oral care solution for bacterial colonization （P=0.020）.the comparison between three groups of two two,there was statistically significant difference between Normal saline group and Yikou mouth rinse group（P=0.008）,the number of bacterial colonization in Yikou mouth rinse group was less than that in Normal saline group significantly.Efficiency of Yikou mouth rinse