经口气管插管患者三种口腔护理方法的效果观察与安全性探讨

目的：探讨三种口腔护理方法对经口气管插管患者的口腔护理效果和安全性。方法：将符合入组的90例经口气管插管机械通气患者随机分为A、B、C三组，每组各30例。A组患者口腔用3％过氧化氢溶液棉球擦洗加生理盐水冲洗；B组只用生理盐水冲洗；C组按常规用生理盐水棉球擦洗，均每日2次。观察三组患者口咽部细菌数、口腔pH值和清洁度及口腔炎的发生率，以比较三种护理方法的效果和护理操作的安全性。结果：三种方法护理口腔后，三组口咽部细菌数均减少，以A组细菌数减少最明显；口腔pH值以A组升高最明显；口垢及口腔炎的发生率虽无差异，但口臭发生率有明显差异（P〈0．05），且以A组最低。三组患者均无导管移位、脱落及误吸事件发生。结论：用3％过氧化氢溶液棉球擦洗＋生理盐水冲洗更能去除患者口咽部细菌，只要操作得当，经口气管插管患者的口腔护理是安全的。

Observation on the effect and exploration for the safety of the three methods of nursing care for oral cavities of the patients with orotracheal intubation

Objective To explore the effect and safety of the three methods of nursing care for oral cavities of the patients with oro- tracheal intubation. Methods Ninety patients with orotracheal intubation for mechanical ventilation who were qualified for this study Were randomly divided into three groups, Group A, Group B and Group C, 30 patients in each group. The patients in Group A were washed with cotton balls soaked by 3% hydrogen peroxide solution and rinsed with normal saline; the patients in Group B were rinsed with normal saline alone; the patients in Group C were washed conventionally with cotton balls soaked by normal saline. The oral care was conducted twice daily in each group. The bacterial number in pharyngo - oral cavities, the pH values, the clean degrees of oral cavities and the incidence of stomatitis were observed comparing the effect and the safety of nursing manipulation of these three meth- ods. Results After oral care in three ways, the bacterial number in pharyngo - oral cavities of the patients in all these three groups de- creased, and the decrease in bacterial number in Group A was most significant. The oral pH values of the patients in Group A were found to rise most markedly. Although the incidence of oral filth and that of stomatitis did not show significant difference, the inci- dence of halitosis showed significant difference （ P 〈 0. 05 ）. The incidence of halitosis in the patients in Group A was lowest. In the three groups, the endotracheal tubes were not found to have shifted or falling from tracheas, the polluted water was not sucked into the lungs of the patients. Conclusion Washing oral cavities with cotton balls soaked by 3% hydrogen peroxide solution plus rinsing with normal saline can more effectively eliminate the bacteria in pharyngo - oral cavities of the patients. The nursing care for oral cavities of the patients with orotracheal intubation is safe provided if it is properly operated.