口腔相關(guān)護(hù)理ICU護(hù)士新認(rèn)識(shí)

口腔相關(guān)護(hù)理ICU護(hù)士新認(rèn)識(shí)第1頁(yè)/共58頁(yè)你、我、他每個(gè)人...每天......TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第2頁(yè)/共58頁(yè)一般患者...ICU患者...口腔護(hù)理口腔護(hù)理TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第3頁(yè)/共58頁(yè)方法一樣嗎...?達(dá)到效果一樣嗎...?TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第4頁(yè)/共58頁(yè)方法一樣嗎...?達(dá)到效果一樣嗎...?你懂得...TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第5頁(yè)/共58頁(yè)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(yíng)養(yǎng)護(hù)理胃腸功能護(hù)理個(gè)人衛(wèi)生護(hù)理......TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第6頁(yè)/共58頁(yè)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(yíng)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第7頁(yè)/共58頁(yè)第8頁(yè)/共58頁(yè)第9頁(yè)/共58頁(yè)中華內(nèi)科雜志2013年6月第52卷第6期TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第10頁(yè)/共58頁(yè)AJCCAMERICANJOURNALOFCRITICALCARE,March2010,Volume19,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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第11頁(yè)/共58頁(yè)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(kāi)始時(shí)沒(méi)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(duì)照組達(dá)66%（P<0.05）。TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第12頁(yè)/共58頁(yè)生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第13頁(yè)/共58頁(yè)生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......q12hq8hq6hq4hq2hTheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第14頁(yè)/共58頁(yè)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?jí)K......TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第15頁(yè)/共58頁(yè)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)生的一種主要方法TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第16頁(yè)/共58頁(yè)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第17頁(yè)/共58頁(yè)ICU護(hù)士：口腔衛(wèi)生評(píng)估？護(hù)理效果評(píng)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......？TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第18頁(yè)/共58頁(yè)ICU護(hù)士：口腔衛(wèi)生評(píng)估？護(hù)理效果評(píng)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第19頁(yè)/共58頁(yè)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(lèi)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VAP發(fā)生。TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第20頁(yè)/共58頁(yè)目的：通過(guò)研究來(lái)評(píng)價(jià)ICU護(hù)士對(duì)于機(jī)械通氣患者口腔護(hù)理的觀(guān)點(diǎn)以及執(zhí)行情況TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第21頁(yè)/共58頁(yè)53名學(xué)歷ICU工作時(shí)間雇傭形式53名護(hù)士基本情況TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第22頁(yè)/共58頁(yè)每班次口腔評(píng)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(zhuān)用口腔護(hù)理表格）TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第23頁(yè)/共58頁(yè)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(zhuān)用口腔護(hù)理表格TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第24頁(yè)/共58頁(yè)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第25頁(yè)/共58頁(yè)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(yíng)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(shū)寫(xiě)腸道功能護(hù)理TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第26頁(yè)/共58頁(yè)列舉12種口腔護(hù)理材料和工具，并且對(duì)每種材料和工具1至100分打分，得分高者說(shuō)明口腔護(hù)理時(shí)使用的頻次越高TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第27頁(yè)/共58頁(yè)12種口腔護(hù)理材料和工具使用頻次紗布?jí)K氯己定生理鹽水口腔沖洗TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第28頁(yè)/共58頁(yè)列出口腔護(hù)理的10種障礙原因，然后對(duì)其1至10分打分，分值越高者口腔護(hù)理障礙原因越常見(jiàn)TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第29頁(yè)/共58頁(yè)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(shū)寫(xiě)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(méi)關(guān)系TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第30頁(yè)/共58頁(yè)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第31頁(yè)/共58頁(yè)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(zhuān)用口腔護(hù)理表格TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第32頁(yè)/共58頁(yè)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(yíng)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(shū)寫(xiě)腸道功能護(hù)理TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第33頁(yè)/共58頁(yè)12種口腔護(hù)理材料和工具使用頻次紗布?jí)K氯己定生理鹽水口腔沖洗TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第34頁(yè)/共58頁(yè)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(shū)寫(xiě)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(méi)關(guān)系TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第35頁(yè)/共58頁(yè)口腔護(hù)理雖說(shuō)排名第二，但其分值和其他皮膚護(hù)理，導(dǎo)管維護(hù)，營(yíng)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第36頁(yè)/共58頁(yè)結(jié)果顯示很有必要為護(hù)士開(kāi)設(shè)口腔護(hù)理再培訓(xùn)課程TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第37頁(yè)/共58頁(yè)47%的護(hù)士認(rèn)為口腔護(hù)理不是非常重要GrapMJ,MunroCL,AshtianiB,BryantS.Oralcareinterventionsincriticalcare:frequencyanddocumentation.AmJCritCare.2003;12(2):113–8.discussion119.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第38頁(yè)/共58頁(yè)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第39頁(yè)/共58頁(yè)這篇研究中85%的參與者培訓(xùn)過(guò)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(méi)有培訓(xùn)過(guò)應(yīng)用機(jī)械通氣患者口腔護(hù)理Adib-HajbagheryM,AnsariA,Azizi-FiniI.Intensivecarenurses'opinionsandpracticefororalcareofmechanicallyventilatedpatients.IndianJCritCareMed.2013;17(1):23–7.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第40頁(yè)/共58頁(yè)又有研究報(bào)道：在英國(guó)，62%的護(hù)士說(shuō)在這個(gè)領(lǐng)域內(nèi)接受過(guò)培訓(xùn)JonesH,NewtonJT,BowerEJ.Asurveyoftheoralcarepracticesofintensivecarenurses.IntensiveCritCareNurs.2004;20(2):69–76.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第41頁(yè)/共58頁(yè)另外在一篇研究：在歐洲的ICU顯示，77%的ICU護(hù)士接受過(guò)相關(guān)的培訓(xùn)RelloJ,KoulentiD,BlotS,SierraR,DiazE,DeWaeleJJ,etal.Oralcare

practicesinintensivecareunits:asurveyof59EuropeanICUs.IntensiveCareMed.2007;33(6):1066–70.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第42頁(yè)/共58頁(yè)在這篇研究中，盡管大多數(shù)護(hù)士都接受過(guò)此類(lèi)口腔護(hù)理培訓(xùn)，但是在口腔護(hù)理方面并沒(méi)有給出高的優(yōu)先分?jǐn)?shù)TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第43頁(yè)/共58頁(yè)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TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第44頁(yè)/共58頁(yè)另外研究發(fā)現(xiàn)：擔(dān)負(fù)書(shū)寫(xiě)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-HajbagheryM,AnsariA,Azizi-FiniI.Intensivecarenurses'opinionsandpracticefororalcareofmechanicallyventilatedpatients.IndianJCritCareMed.2013;17(1):23–7.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第45頁(yè)/共58頁(yè)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RelloJ,KoulentiD,BlotS,SierraR,DiazE,DeWaeleJJ,etal.Oralcarepracticesinintensivecareunits:asurveyof59EuropeanICUs.IntensiveCareMed.2007;33(6):1066–70TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第46頁(yè)/共58頁(yè)本文調(diào)查：口腔沖洗是最常用的方法用于口腔護(hù)理TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第47頁(yè)/共58頁(yè)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(duì)于ICU患者PedreiraML,KusaharaDM,deCarvalhoWB,NunezSC,Peter-liniMA.Oralcareinterventionsandoropharyngealcoloniza-tioninchildrenreceivingmechanicalventilation.AmJCritCare.2009;18(4):319–28.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第48頁(yè)/共58頁(yè)有研究顯示：用氯己定口腔沖洗比牙刷刷洗更能減少VAP。MunroCL,GrapMJ,JonesDJ,McClishDK,SesslerCN.Chlorhexi-dine,toothbrushing,andpreventingventilator-associatedpneu-moniaincriticallyilladults.AmJCritCare.2009;18(5):428–37.TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第49頁(yè)/共58頁(yè)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。TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine第50頁(yè)/共58頁(yè)開(kāi)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(duì)于機(jī)械通氣患者口腔護(hù)理，執(zhí)行情況管理可以