口腔護(hù)理icu護(hù)士新認(rèn)識(shí)

1、口腔護(hù)理,蚌醫(yī)一附院重癥醫(yī)學(xué)科,ICU護(hù)士新認(rèn)識(shí),The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,你、我、他 每個(gè)人... 每天......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,一般

2、患者...,ICU患者...,口腔護(hù)理,口腔護(hù)理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,方法一樣嗎...?,達(dá)到效果一樣嗎...?,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,方法一樣嗎...?,達(dá)到效果一

3、樣嗎...?,你懂得...,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,皮膚護(hù)理氣道護(hù)理口腔護(hù)理毛發(fā)護(hù)理眼部護(hù)理腸內(nèi)營養(yǎng)護(hù)理胃腸功能護(hù)理個(gè)人衛(wèi)生護(hù)理......,The First Affiliated Hospital of Bengbu Medical College in intensive medic

4、ine,,皮膚護(hù)理氣道護(hù)理口腔護(hù)理毛發(fā)護(hù)理眼部護(hù)理腸內(nèi)營養(yǎng)護(hù)理胃腸功能護(hù)理個(gè)人衛(wèi)生護(hù)理......,護(hù)士心中重要性,排序,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,,J Bras Pneumol. 2008;34(9):707-714,The First Affiliated Hospital of Ben

5、gbu Medical College in intensive medicine,口咽部分泌物的吸入是VAP發(fā)生的最主要途徑,,,J Bras Pneumol. 2008;34(9):707-714,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,中華內(nèi)科雜志2013年6月第52卷第6期,The First Affiliate

6、d Hospital of Bengbu Medical College in intensive medicine,,,AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2010, Volume 19, No. 2,顯示：50%的護(hù)士認(rèn)為每2小時(shí)一次口腔護(hù)理，42%的護(hù)士認(rèn)為每4小時(shí)一次口腔護(hù)理,The First Affiliated Hospital of Bengbu Medical

7、College in intensive medicine,,有報(bào)道：應(yīng)用0.2%的氯己定葡萄酸糖溶液和安慰劑進(jìn)行的前瞻性多中心雙盲試驗(yàn)，每天3次應(yīng)用，開始時(shí)沒有統(tǒng)計(jì)學(xué)差異，第10天時(shí)，0.2%氯己定葡萄酸糖溶液組牙周致病菌29%，而對照組達(dá)66%（P<0.05）。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,生理鹽水

8、稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,q12hq8hq6hq4hq2h,The First Affiliated Hospital of Bengbu Medical College in

9、 intensive medicine,,生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,q12hq8hq6hq4hq2h,刷、沖、洗、沖洗、沖刷......,牙刷、棉球、紗布塊......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,,,有研究顯示：檢查口腔衛(wèi)生是應(yīng)用呼吸機(jī)病人預(yù)防VAP發(fā)生的一

10、種主要方法,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,研究顯示：隨著正規(guī)合格的口腔護(hù)理，VAP發(fā)生率在降低,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護(hù)士： 口腔衛(wèi)生評估？

11、 護(hù)理效果評價(jià)？ 口腔護(hù)理再培訓(xùn) ？ 口腔護(hù)理執(zhí)行管理？,如何選擇......？,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護(hù)士： 口腔衛(wèi)生評估？ 護(hù)理效果評價(jià)？ 口腔

12、護(hù)理再培訓(xùn) ？ 口腔護(hù)理執(zhí)行管理？,如何選擇......？,思考,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,背景：很多創(chuàng)傷患者入住ICU，通常需要機(jī)械通氣，經(jīng)口氣管插管使口腔氣道的天然防御機(jī)制受損，此類病人VAP發(fā)生幾率比較高。證據(jù)顯示：多關(guān)注機(jī)械通氣患者口腔衛(wèi)生非常有助于預(yù)防

13、VAP發(fā)生。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,目的：通過研究來評價(jià)ICU護(hù)士對于機(jī)械通氣患者口腔護(hù)理的觀點(diǎn)以及執(zhí)行情況,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,53名,,學(xué)歷,,ICU工作時(shí)間,,雇

14、傭形式,53名護(hù)士基本情況,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,每班次口腔評估次數(shù)，每班次每患者口腔護(hù)理次數(shù)，是否按規(guī)定的時(shí)間、規(guī)定的方法進(jìn)行口腔護(hù)理（專用口腔護(hù)理表格）,The First Affiliated Hospital of Bengbu Medical College in intensive me

15、dicine,機(jī)械通氣患者提出護(hù)理頻次,,每班次檢查口腔的次數(shù),每班次每患者口腔護(hù)理的次數(shù),,,應(yīng)用專用口腔護(hù)理表格,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,關(guān)于列出的十個(gè)日常護(hù)理規(guī)程，每個(gè)護(hù)理規(guī)程進(jìn)行1至10分打分，分值越高者就是優(yōu)先傾向于做的護(hù)理規(guī)程,The First Affiliated Hospital of

16、Bengbu Medical College in intensive medicine,10項(xiàng)日常護(hù)理規(guī)程得分平均值和標(biāo)準(zhǔn)差,氣管管理,口腔護(hù)理,皮膚護(hù)理,營養(yǎng)護(hù)理,導(dǎo)管維護(hù),個(gè)人衛(wèi)生,眼部護(hù)理,預(yù)防機(jī)體超負(fù)荷,記錄單書寫,腸道功能護(hù)理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,列舉12種口腔護(hù)理材料和工具，并且對每種材

17、料和工具1至100分打分，得分高者說明口腔護(hù)理時(shí)使用的頻次越高,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,12種口腔護(hù)理材料和工具使用頻次,紗布塊,氯己定,生理鹽水,口腔沖洗,The First Affiliated Hospital of Bengbu Medical College in intensive medici

18、ne,,列出口腔護(hù)理的10種障礙原因，然后對其1至10分打分，分值越高者口腔護(hù)理障礙原因越常見,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,護(hù)士進(jìn)行口腔護(hù)理障礙原因,人員不足,時(shí)間缺乏,擔(dān)負(fù)書寫任務(wù),害怕感染轉(zhuǎn)移,缺乏設(shè)備,氣管插管存在,不重要,缺乏知識(shí)和能力,害怕吸引,不愉快,和我沒關(guān)系,The First Affiliat

19、ed Hospital of Bengbu Medical College in intensive medicine,,53名,,學(xué)歷,,ICU工作時(shí)間,,雇傭形式,53名護(hù)士基本情況,,理學(xué)士,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,機(jī)械通氣患者提出護(hù)理頻次,,每班次檢查口腔的次數(shù),每班次每患者口腔護(hù)理的次數(shù),,,應(yīng)

20、用專用口腔護(hù)理表格,,,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,10項(xiàng)日常護(hù)理規(guī)程得分平均值和標(biāo)準(zhǔn)差,氣管管理,口腔護(hù)理,皮膚護(hù)理,營養(yǎng)護(hù)理,導(dǎo)管維護(hù),個(gè)人衛(wèi)生,眼部護(hù)理,預(yù)防機(jī)體超負(fù)荷,記錄單書寫,腸道功能護(hù)理,,The First Affiliated Hospital of Bengbu Medical Colle

21、ge in intensive medicine,12種口腔護(hù)理材料和工具使用頻次,紗布塊,氯己定,生理鹽水,口腔沖洗,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,護(hù)士進(jìn)行口腔護(hù)理障礙原因,人員不足,時(shí)間缺乏,擔(dān)負(fù)書寫任務(wù),害怕感染轉(zhuǎn)移,缺乏設(shè)備,氣管插管存在,不重要,缺乏知識(shí)和能力,害怕吸引,不愉快,和我沒關(guān)系,,The

22、First Affiliated Hospital of Bengbu Medical College in intensive medicine,口腔護(hù)理雖說排名第二，但其分值和其他皮膚護(hù)理，導(dǎo)管維護(hù)，營養(yǎng)護(hù)理，個(gè)人衛(wèi)生分值差不多，并且遠(yuǎn)遠(yuǎn)落后于氣道管理,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,結(jié)果顯示很有必要為護(hù)士開

23、設(shè)口腔護(hù)理再培訓(xùn)課程,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,47%的護(hù)士認(rèn)為口腔護(hù)理不是非常重要,Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and documentation.

24、 Am J Crit Care. 2003;12(2):113–8. discussion 119.,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,有必要進(jìn)行護(hù)士口腔護(hù)理再培訓(xùn)以及在預(yù)防呼吸道感染中擔(dān)當(dāng)一定的角色,The First Affiliated Hospital of Bengbu Medical College

25、 in intensive medicine,,這篇研究中85%的參與者培訓(xùn)過應(yīng)用機(jī)械通氣患者口腔護(hù)理而另外一篇報(bào)道70%的護(hù)士沒有培訓(xùn)過應(yīng)用機(jī)械通氣患者口腔護(hù)理,Adib-Hajbaghery M, Ansari A, Azizi-Fini I. Intensive care nurses' opinions and practice for oral care of mechanically ventilated pati

26、ents. Indian J Crit Care Med. 2013;17(1):23–7.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,又有研究報(bào)道：在英國，62%的護(hù)士說在這個(gè)領(lǐng)域內(nèi)接受過培訓(xùn),Jones H, Newton JT, Bower EJ. A survey of the oral care practice

27、s of intensive care nurses. Intensive Crit Care Nurs. 2004;20(2):69–76.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,另外在一篇研究：在歐洲的ICU顯示，77%的ICU護(hù)士接受過相關(guān)的培訓(xùn),Rello J, Koulenti D, Blot S, Sier

28、ra R, Diaz E, De Waele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33(6):1066–70.,The First Affiliated Hospital of Bengbu Medical College in intensive me

29、dicine,,在這篇研究中，盡管大多數(shù)護(hù)士都接受過此類口腔護(hù)理培訓(xùn)，但是在口腔護(hù)理方面并沒有給出高的優(yōu)先分?jǐn)?shù),The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,此研究提到：缺乏時(shí)間和人員不足是忽視機(jī)械通氣患者口腔護(hù)理的最主要因素,The First Affiliated Hospital of Bengbu Medical C

30、ollege in intensive medicine,,另外研究發(fā)現(xiàn)：擔(dān)負(fù)書寫任務(wù)以及時(shí)間、人員不足是ICU口腔護(hù)理的最大障礙,Adib-Hajbaghery M, Ansari A, Azizi-Fini I. Intensive care nurses' opinions and practice for oral care of mechanically ventilated patients. Indian J Cr

31、it Care Med. 2013;17(1):23–7.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,又有研究發(fā)現(xiàn)：在歐洲59個(gè)ICU調(diào)查顯示，三分之一的護(hù)士認(rèn)為口腔護(hù)理令人不愉快，三分之二的護(hù)士認(rèn)為口腔護(hù)理很難去執(zhí)行,Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Wa

32、ele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33(6):1066–70,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,本文調(diào)查：口腔沖洗是最常

33、用的方法用于口腔護(hù)理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,另外一篇研究不一致：強(qiáng)調(diào)牙刷刷洗最有助于清除口腔的菌斑和微生物對于ICU患者,Pedreira ML, Kusahara DM, de Carvalho WB, Nunez SC, Peter-lini MA. Oral care interventions

34、and oropharyngeal coloniza-tion in children receiving mechanical ventilation. Am J Crit Care. 2009;18(4):319–28.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,有研究顯示：用氯己定口腔沖洗比牙刷刷洗更能減少VAP。,

35、Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexi-dine, toothbrushing, and preventing ventilator-associated pneu-monia in critically ill adults. Am J Crit Care. 2009;18(5):428–37.,The First Affiliated Hospit

36、al of Bengbu Medical College in intensive medicine,,又有研究顯示：機(jī)械刷洗遠(yuǎn)比棉球擦洗和氯己定沖洗效果好。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,開設(shè)再培訓(xùn)課程強(qiáng)調(diào)口腔護(hù)理重要性，口腔護(hù)理真實(shí)執(zhí)行情況。對于機(jī)械通氣患者口腔護(hù)理，執(zhí)行情況管理可以進(jìn)一步研究。,The F

37、irst Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護(hù)士： 口腔衛(wèi)生評估？ 護(hù)理效果評價(jià)？ 口腔護(hù)理再培訓(xùn) ？ 口腔護(hù)理執(zhí)行管理？,如何選擇......？,思考,The First Affiliated Hospital o

38、f Bengbu Medical College in intensive medicine,,ICU護(hù)士： 口腔衛(wèi)生評估？ 護(hù)理效果評價(jià)？ 口腔護(hù)理再培訓(xùn) ？ 口腔護(hù)理執(zhí)行管理？,如何選擇......？,思考,答案,The First Affiliated Hospital of Bengbu Medical Colleg

39、e in intensive medicine,,ICU護(hù)士口腔護(hù)理再培訓(xùn)口腔護(hù)理重要性VAP所起的作用再認(rèn)識(shí)機(jī)械通氣患者口腔護(hù)理方法選擇口腔衛(wèi)生評估口腔護(hù)理效果評價(jià)口腔護(hù)理執(zhí)行管理再研究,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,將來的不久... 會(huì)有新的認(rèn)識(shí)... 有新的選擇...