摘要
目的评价口腔冲洗应用于气管插管危重患者口腔护理的效果。方法计算机检索Cochrane Library、Joanna Briggs Institute Library、MEDLINE、RNAO、OVID、Web of Knowledge、Nursing Consult、EMbase、CINAHL、中国高等教育文献保障系统(CALIS)、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI),以及万方数据资源系统中关于口腔冲洗应用于气管插管危重患者的随机对照试验、类实验性研究及队列研究,同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的研究进行meta分析。结果共纳入12项RCT及1项类实验性研究,1759例患者。meta分析结果证实,口腔冲洗应用于气管插管危重患者有助于降低呼吸机相关性肺炎(VAP)发生率[RR=0.46,95%CI(0.37,0.56),P<0.001],但单纯行口腔冲洗法降低VAP发生率的效果并不显著[RR=0.55,95%CI(0.21,1.47),P=0.24];冲洗与擦洗相结合的口腔护理方式能显著减少口腔并发症、VAP及口臭的发生[RR=0.16,95%CI(0.09,0.27),P<0.001;RR=0.40,95%CI(0.28,0.58),P<0.001;RR=0.09,95%CI(0.04,0.21),P<0.001];冲洗与刷洗结合亦有助于减少口腔并发症及VAP的发生[RR=0.34,95%CI(0.14,0.83),P=0.02;RR=0.49,95%CI(0.27,0.87),P=0.01]。结论对于气管插管的危重症患者而言,口腔冲洗联合擦洗或刷洗法可显著降低VAP及口腔并发症的发生率,改善ICU患者的口腔状况,建议临床推广使用。
Objective To evaluate the effectiveness of oral rinsing in critically ill patients with endotracheal intubation. Methods The randomized controlled trials （RCTs）,quasi-experimental studies and cohort studies on the application of oral rinsing in critically ill patients with endotraeheal intubation were collected through the databases such as the Cochrane Library,Joanna Briggs Institute Library,MEDLINE,RNAO,OVID,Web of Knowledge, Nursing Consult,EMbase, CINAHL,CALIS, CBM,CNKI and Wanfang Data. The quality of studies was critically appraised and data were extracted by two reviewers independently,and meta-analysis was conducted for the included studies. Results Twelve RCTs and one quasi-experimental study involving 1759 patients were included. Meta-analysis showed that the application of oral rinsing in critically ill patients with endotracheal intubation could contribute to the reduction of the incidence of ventilator-associated pneumonia（VAP）[RR=0.46,95% Cl（0.37,0.56）,P〈O.OOl],but the efficacy was not significant when applying oral rinse alone[RR--O.55,95%Cl（O.21,1.47）,P=0.24]; while oral rinse combined with swabbing could significantly reduce the incidence of oral eomplications,VAP and halitosis[RR= 0.16,95% CI （0.09,0.27）, P〈0.001 ; RR =0.40,95 % CI （ 0.28,0.58 ）, P〈0.001 ; RR =0.09,95 % CI （ 0.04,0.21 ）, P〈0.001 ] ; oral rinsing combined with brushing could also reduce the incidence of oral complications and VAPERR=O.34,95%CI（O.14,0.83）,P=O.02; RR=O.49,95%CI（O.27,0.87）,P=O.O1]. Conclusions The application of oral rinsing combined with swabbing or brushing in critically ill patients with endotracheal intubation can significantly decrease the incidence of VAP and oral complications,and improve the oral status. It is worth being popularized.
出处
《中华护理杂志》
CSCD
北大核心
2013年第11期965-970,共6页
Chinese Journal of Nursing
基金
复旦大学护理科研基金项目(编号:FNF201011)
关键词
插管法
气管内
口腔
护理
META分析
Intubation,Intratracheal
Mouth
Nursing Care
Meta-Analysis
