老年口腔肿瘤患者围手术期呼吸道护理

目的:探讨老年口腔肿瘤患者围手术期呼吸道护理。方法:选择我院2009年5月-2011年5月收治的老年口腔肿瘤行手术治疗的患者80例,随机分为两组,对照组40例采用常规护理,观察组40例在此基础上行围手术期整体护理干预,就两组临床资料进行回顾性分析。结果:观察组术后肺部感染1例,痊愈率为97.5%。对照组术后肺部感染5例,呼吸衰竭1例,痊愈率为85%,观察组临床治愈率明显优于对照组,差异有统计学意义,(P>0.05)。结论:老年口腔肿瘤患者加强围手术期护理干预,可显著提高临床治愈率,降低并发症发生率,改善患者生存质量。     

口腔癌伴糖尿病患者围手术期护理体会

目的 探讨口腔癌伴糖尿病患者的围手术期护理要点.方法 总结10例口腔癌伴糖尿病患者的围手术期护理经验.结果 10例患者中7例术后血糖稳定, 2例出现低血糖反应, 1例出现下肢肿胀,对症治疗后均无并发症,痊愈出院.结论 加强口腔癌合并糖尿病患者的围手术期护理可以促进患者的早日康复.     

基于数据挖掘技术的老年口腔癌患者围术期并发症发生概率评估系统的建立

目的:开发一种具有较强临床实用性的老年口腔癌患者围术期并发症发生概率评估系统,使得相关并发症发生概率的评估更加直观与高效.方法:根据APACHEⅡ以及POSSUM评分体系,结合临床实际,确定核心数据项目.采用数据挖掘方法,分析各项临床数据之间潜在的逻辑关系,并以CAG为平台,开发评估系统.结果:历时7个月,整理收集并回顾性录入513个病例的临床数据,建立包含49个临床录入项目的50×513维数据集(数据库).经过一系列测试后,采用随机森林算法作为核心算法,建立预测评估模型,进而开发出预测系统(软件),为系统设置自我学习功能,并计划添加数据导出与网络化功能.结论:本评估系统在老年口腔癌患者围术期并发症发生概率的预测中具有较高的临床实用性.     

基于德尔菲法的口腔颌面头颈肿瘤患者气管切开居家护理方案的构建

目的: 构建口腔颌面头颈肿瘤患者气管切开居家护理方案。方法: 在前期文献分析、半结构式访谈及理论框架的基础上,构建口腔颌面头颈肿瘤患者气管切开居家护理方案初稿。通过德尔菲法对15名专家进行2轮咨询,得到最终方案。采用SPSS 25.0软件包对数据进行统计分析。结果: 2轮专家咨询回收率均为100%,整体专家权威系数为0.88。重要性变异系数为0~0.16,可行性变异系数为0~0.17。最终构建的方案包括4个一级指标、9个二级指标和31个三级指标。结论: 口腔颌面头颈肿瘤患者气管切开居家护理方案符合该群体的居家照护需求,方案构建具有科学性、可行性,能为临床护理实践提供参考依据。     

口腔肿瘤合并糖尿病的围术期处理

目的 探讨口腔肿瘤合并糖尿病的围术处理。方法 对13例合并糖尿病患者在围术期严密监测血糖变化,及时有效的采用降糖药物和胰岛素控制血糖在最佳数值内。结果 13例合并糖尿病患者,均于术后7d拆线切口甲级愈合。结论 对合并糖尿病患者手术前后进行及时正确处理,可使病人安全耐受手术,避免低血糖和酮症酸中毒,减少感染,增强伤口愈合力。     

疼痛管理对口腔种植围术期患者的影响

目的:探讨口腔种植患者围术期疼痛管理方法,提高对口腔门诊种植手术患者的护理水平.方法:纳入100例口腔门诊种植手术患者,以随机抽签方式分为管理组和对照组,管理组采用疼痛管理干预手段进行护理,对照组仅采用传统常规护理,对2组患者的术后疼痛及满意度进行比较.采用SPSS 16.0软件包对评价结果进行x2检验.结果:在2组紧张程度相同的情况下,管理组患者的疼痛率降低,满意率高,与对照组之间差异显著(P＜0.05).结论:通过对口腔种植患者进行围术期疼痛管理,可有效减轻不适感,提高患者的满意度,有利于及早康复.     

51例高龄口腔癌患者的围手术期处理

目的　回顾总结 5 1例 70岁以上高龄口腔癌患者围手术期处理的经验和教训。方法　分析 1992年1月～ 1999年 6月经孙逸仙纪念医院治疗的 5 1例高龄口腔癌患者的住院记录。结果　 49例顺利完成手术治疗 ,康复出院 ,2例分别于术后当晚和第 4天死亡。结论　通过完善的围手术期处理 ,可以成功为高龄口腔癌患者施行手术 ,提高其生存率和生存质量 ;高龄并不是口腔癌手术禁忌     

口腔种植围手术期心理护理分析

选择2010年1月至2012年12月在我院口腔种植科患者360例,其中男性206例,女性154例,涉及上颌窦提升手术86例,植骨术64例.按患者就诊顺序给每位患者编号,奇数患者为心理护理组,偶数患者为对照组,每位患者初次就诊心理护理前和心理护理后（术后24h）分别填写改良牙科焦虑量表（modified dental anxiety scale,MDAS）[1],评估患者牙科焦虑情况.MDAS由4个问题条目组成,每条目5个备选答案,分值1-5分,4题选项分数之和为MDAS得分,MDAS评分≥1 1分可诊断为牙科焦虑症.     

老年患者围术期心电监测的临床意义

通过对１２６例颌面外科的老年患者（６０岁以上）围术期心电监测的回顾性研究，结果显示大多数患者表现为Ｑ－Ｔ间期延长，Ｓ－Ｔ段上抬下移和Ｔ波低平或倒置；其次为Ｉ度房室传导阻滞，心动过缓和室性早搏，统计表明，术中出现心电异常患者人数均比术前高。本文为老年患者围术期可能出现的心电异常的预防和处理提供参考。     

老年口腔牙列缺损患者微创种植围手术期的护理

目的：探讨老年口腔牙列缺失患者微创种植牙的围手术期护理方法。方法：对2010年1月至2012年10月间在解放军总医院口腔种植科行微创种植手术的患者115例进行回顾性分析,总结老年微创种植牙的围手术护理方法。结果：全部患者在种植手术过程中生命体征平稳,种植体植入顺利患者感觉良好,种植体存活率达94.01％,术后未出现种植体周围炎等并发症,患者基本能按要求维护种植体。结论：口腔种植围手术期良好的护理是种植牙手术成功的关键因素之一,细致精心的口腔护理可提高种植体存活率,促进患者顺利康复。     

Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period

Objective:

During the perioperative period, oral ingestion is changed considerably in esophagectomy patients. The aim of this study was to investigate oral environment modifications in patients undergoing esophageal cancer treatments due to changes in dietary intake and swallowing functions.

Material and Methods:

Thirty patients who underwent operation for removal of esophageal cancer in Tokushima University Hospital were enrolled in this study.

Results:

It was found that 1) the flow rate of resting saliva decreased significantly at postoperative period by deprived feeding for one week, although it did not recover several days after oral ingestion began, 2) the accumulation of dental plaque and the number of mutans streptococci in saliva decreased significantly after operation, while both increased relatively quick when oral ingestion began, and 3) the swallowing function decreased significantly in the postoperative period.

Conclusions:

These results suggest that dental professionals should emphasize the importance of oral health care and provide instructions on plaque control to patients during the perioperative period of esophageal cancer treatment.     

The rational use of oral care products in the elderly

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.Affiliation: Robin Davies is an employee of Colgate-Palmolive (UK)     

晚期口腔癌患者术后家庭照顾者的需求现状

口腔癌是头颈部常见的恶性肿瘤。晚期口腔癌患者主要以手术治疗为主,由于专科护士缺乏及社区医院的供不应求,家庭照顾者需承担所有的生活照顾。知识和经验的缺乏,使得他们在照顾过程中产生了一系列需求。本文综述了照顾者的此类需求,以期为临床提供参考。     

右美托咪定预防老年口腔肿瘤患者术后谵妄的疗效分析

目的 评价右美托咪定预防老年口腔肿瘤患者术后谵妄的临床效果。方法选取156例在全麻下行根治术的老年口腔肿瘤患者,随机分为观察组（78例）和对照组（78例）。所有患者手术结束后经过2 h的麻醉复苏室过渡后转入SICU。随后,观察组给予静脉泵注生理盐水稀释的右美托咪定注射液0.2μg/(kg·h)维持12 h,对照组给予等体积的生理盐水静脉泵注。所有患者术后都给予同样剂量的曲马多+托烷司琼镇痛。在术后3 d内,每天8:00和20:00按照CAM-ICU（confusion assessment method for the intensive care unit）方法评估谵妄发生情况,并进行VAS疼痛评分和Richmond镇静躁动评分（richmond agitation sedation scale,RASS）。采用SPSS16.0软件包对数据进行统计学分析。结果观察组患者术后疼痛评分、术后心动过缓和低血压发生率与对照组比较无显著差异,2组均无呼吸抑制发生。观察组术后第1天及第2天的镇静躁动评分优于对照组。观察组术后谵妄、恶心、呕吐发生率低于对照组。结论右美托咪定术后0.2 μg/kg.h 维持12 h,可改善老年口腔肿瘤患者的术后镇静状况,减少术后谵妄发生,且不会引起心动过缓及低血压。     

Target outcomes for long-term oral health care in dementia: a Delphi approach

This study developed a list of target outcomes for long-term oral health care in persons with dementia. A three-round Delphi study was used to develop a list of target outcomes. Participants included 99 staff and 171 family members associated with the Dementia Special Care Unit in Bedford, MA. In Round 1 participants were asked to list five outcomes for long-term oral health care. Items were grouped, redundancies removed, and fed back in Round 2, when participants scored the items from 1 (least important) to 10 (most important). Round 2 responses were tabulated and the top 20 were fed back for scoring in Round 3. The top 10 target outcomes in decreasing order of importance were: patient will be free from oral pain, patient will not be at risk for aspiration, emergency dental treatment will be available when needed, prevent mouth infections, daily mouth care is as much a part of daily care as shaving or brushing hair, prevent discomfort from loose teeth or sore gums, teeth will be brushed thoroughly once a day, staff will be able to provide oral hygiene care as needed, provide dental care to prevent problems eating, and recognize oral problems early. Family and professional caregivers were remarkably consistent in their identification of the top 10 outcomes. Further work is needed to ensure broad international and interdisciplinary acceptance (including families and the long-term care residents themselves) of target outcomes for long-term oral health care in persons with dementia.     

Quality of life of Japanese elderly oral cancer patients during the perioperative period

Japan’s aging society has an increasing incidence of oral cancer. This study investigated perioperative changes in quality of life (QoL) among 172 oral cancer patients (elderly ≥75 years vs non-elderly <75 years), pre-treatment, at treatment completion, and at 1, 3, and 6 months post-treatment, using the following Functional Assessment of Cancer Therapy – Head and Neck (FACT-H&N) subscales: physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional head- and neck-specific concerns (H&N). SWB (P = 0.026), H&N (P = 0.024), and total FACT-H&N (P = 0.009) scores were significantly lower in the elderly group than in the non-elderly group at 6 months post-treatment, especially for mastication items (H&N1, P = 0.047; H&N11, P = 0.004), but not for swallowing items (H&N5 and H&N7, both P >  0.05). PWB (P =  0.004), EWB (P <  0.001), and FWB (P =  0.022) scores in the non-elderly group were significantly higher at 6 months post-treatment than before treatment. In the elderly group, no subscale showed a better score at 6 months post-treatment. Post-treatment QoL in elderly oral cancer patients did not improve, unlike in non-elderly patients.     

Terminal care for oral cancer patients in hospital dentistry and oral and maxillofacial surgery at a local area

A sequential study concerning suicide of patients with oral cancer, notification of oral cancer, terminal care of patients with oral cancer at home, etc. has been performed in our department. As part of the study, a possible role of hospital dentistry and oral and maxillofacial surgery at a local area was examined recently with reference to the terminal alleviating care provided to three patients with oral cancer at Joetsu General Hospital. The result was as follows: It is natural that most patients want to die at home in the presence of their family. In order to fulfill such a desire, it is considered necessary that a hospital dentistry and oral and maxillofacial surgery must handle terminal alleviating care. However, many problems still remain in managing patients with terminal cancer in a hospital dentistry. But also a cooperation with a university hospital and cooperation with the department of dentistry in other hospitals, education activity concerning oral cancer at local medical treatment including within hospital care, effective utilization of local nursing station, and examination of the home care system, are considered essential.