口腔相关护理ICU护士新认识-.ppt

口腔护理口腔护理蚌医一附院蚌医一附院重症医学科重症医学科 ICU护士新认识护士新认识The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine你、我、他你、我、他 每个人每个人.每天每天.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine一般患者一般患者.ICU患者患者.口腔护理口腔护理口腔护理口腔护理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine方法一样吗.?达到效果一样吗.?The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine方法一样吗.?达到效果一样吗.?你懂得你懂得.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine皮肤护理气道护理口腔护理毛发护理眼部护理肠内营养护理胃肠功能护理个人卫生护理.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine皮肤护理气道护理口腔护理毛发护理眼部护理肠内营养护理胃肠功能护理个人卫生护理.护士心中重要性护士心中重要性排序排序The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine中华内科杂志2013年6月第52卷第6期The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineAJCC AMERICAN JOURNAL OF CRITICAL CARE,March 2010,Volume 19,No.2显示：显示：50%50%的护的护士认为每士认为每2 2小时小时一次口腔护理，一次口腔护理，42%42%的护士认为的护士认为每每4 4小时一次口小时一次口腔护理腔护理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine有报道：应用0.2%的氯己定葡萄酸糖溶液和安慰剂进行的前瞻性多中心双盲试验，每天3次应用，开始时没有统计学差异，第10天时，0.2%氯己定葡萄酸糖溶液组牙周致病菌29%，而对照组达66%（P0.05）。The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.q12hq8hq6hq4hq2hThe First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.q12hq8hq6hq4hq2h刷、冲、洗、冲洗、冲刷刷、冲、洗、冲洗、冲刷.牙刷、棉球、纱布块牙刷、棉球、纱布块.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine有研究显示：检查口腔卫生是应用呼吸机病人预防VAP发生的一种主要方法The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine研究显示：随着正规合格的口腔护理，VAP发生率在降低The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineICU护士护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？如何选择如何选择.？The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineICU护士护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？如何选择如何选择.？思考思考The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine背景背景：很多创伤患者入住ICU，通常需要机械通气，经口气管插管使口腔气道的天然防御机制受损，此类病人VAP发生几率比较高。证据显示：多关注机械通气患者口腔卫生非常有助于预防VAP发生。The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine目的目的：通过研究来评价ICUICU护士护士对于机械通气患者口腔护理的观点以及执行情况The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine53名名学历学历ICU工作时间工作时间雇佣形式雇佣形式5353名护士基本情况名护士基本情况The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine每班次口腔评估次数，每班次每患者口腔护理次数，是否按规定的时间、规定的方法进行口腔护理（专用口腔护理表格）The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine机械通气患者提出护理频次机械通气患者提出护理频次每班次检查口腔的次数每班次每患者口腔护理的次数应用专用口腔护理表格The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine关于列出的十个日常护理规程，每个护理规程进行1至10分打分，分值越高者就是优先倾向于做的护理规程The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine1010项日常护理规程得分平均值和标准差项日常护理规程得分平均值和标准差气管管理气管管理口腔护理口腔护理皮肤护理皮肤护理营养护理营养护理导管维护导管维护个人卫生个人卫生眼部护理眼部护理预防机体超负荷预防机体超负荷记录单书写记录单书写肠道功能护理肠道功能护理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine列举12种口腔护理材料和工具，并且对每种材料和工具1至100分打分，得分高者说明口腔护理时使用的频次越高The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine1212种口腔护理材料和工具使用频次种口腔护理材料和工具使用频次纱布块纱布块氯己定氯己定生理盐水生理盐水口腔冲洗口腔冲洗The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine列出口腔护理的10种障碍原因，然后对其1至10分打分，分值越高者口腔护理障碍原因越常见The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine护士进行口腔护理障碍原因护士进行口腔护理障碍原因人员不足人员不足时间缺乏时间缺乏担负书写任务担负书写任务害怕感染转移害怕感染转移缺乏设备缺乏设备气管插管存在气管插管存在不重要不重要缺乏知识和能力缺乏知识和能力害怕吸引害怕吸引不愉快不愉快和我没关系和我没关系The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine53名名学历学历ICU工作时间工作时间雇佣形式雇佣形式5353名护士基本情况名护士基本情况理学士理学士The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine机械通气患者提出护理频次机械通气患者提出护理频次每班次检查口腔的次数每班次每患者口腔护理的次数应用专用口腔护理表格The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine1010项日常护理规程得分平均值和标准差项日常护理规程得分平均值和标准差气管管理气管管理口腔护理口腔护理皮肤护理皮肤护理营养护理营养护理导管维护导管维护个人卫生个人卫生眼部护理眼部护理预防机体超负荷预防机体超负荷记录单书写记录单书写肠道功能护理肠道功能护理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine1212种口腔护理材料和工具使用频次种口腔护理材料和工具使用频次纱布块纱布块氯己定氯己定生理盐水生理盐水口腔冲洗口腔冲洗The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine护士进行口腔护理障碍原因护士进行口腔护理障碍原因人员不足人员不足时间缺乏时间缺乏担负书写任务担负书写任务害怕感染转移害怕感染转移缺乏设备缺乏设备气管插管存在气管插管存在不重要不重要缺乏知识和能力缺乏知识和能力害怕吸引害怕吸引不愉快不愉快和我没关系和我没关系The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine口腔护理虽说排名第二，但其分值和其他皮肤护理，导管维护，营养护理，个人卫生分值差不多，并且远远落后于气道管理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine结果显示很有必要为护士开设口腔护理再培训课程The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine47%的护士认为口腔护理不是非常重要 Grap MJ,Munro CL,Ashtiani B,Bryant S.Oral care interventions in critical care:frequency and documentation.Am J Crit Care.2003;12(2):1138.discussion 119.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine有必要进行护士口腔护理再培训以及在预防呼吸道感染中担当一定的角色The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine这篇研究中85%的参与者培训过应用机械通气患者口腔护理而另外一篇报道70%的护士没有培训过应用机械通气患者口腔护理 Adib-Hajbaghery M,Ansari A,Azizi-Fini I.Intensive care nurses opinions and practice for oral care of mechanically ventilated patients.Indian J Crit Care Med.2013;17(1):237.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine又有研究报道：在英国，62%的护士说在这个领域内接受过培训 Jones H,Newton JT,Bower EJ.A survey of the oral care practices of intensive care nurses.Intensive Crit Care Nurs.2004;20(2):6976.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine另外在一篇研究：在欧洲的ICU显示，77%的ICU护士接受过相关的培训 Rello J,Koulenti D,Blot S,Sierra 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):106670.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine在这篇研究中，尽管大多数护士都接受过此类口腔护理培训，但是在口腔护理方面并没有给出高的优先分数The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine此研究提到：缺乏时间和人员不足是忽视机械通气患者口腔护理的最主要因素The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine另外研究发现：担负书写任务以及时间、人员不足是ICU口腔护理的最大障碍 Adib-Hajbaghery M,Ansari A,Azizi-Fini I.Intensive care nurses opinions and practice for oral care of mechanically ventilated patients.Indian J Crit Care Med.2013;17(1):237.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine又有研究发现：在欧洲59个ICU调查显示，三分之一的护士认为口腔护理令人不愉快，三分之二的护士认为口腔护理很难去执行 Rello J,Koulenti D,Blot S,Sierra 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):106670The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine本文调查：口腔冲洗是最常用的方法用于口腔护理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine另外一篇研究不一致：强调牙刷刷洗最有助于清除口腔的菌斑和微生物对于ICU患者 Pedreira ML,Kusahara DM,de Carvalho WB,Nunez SC,Peter-lini MA.Oral care interventions and oropharyngeal coloniza-tion in children receiving mechanical ventilation.Am J Crit Care.2009;18(4):31928.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine有研究显示：用氯己定口腔冲洗比牙刷刷洗更能减少VAP。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):42837.The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine又有研究显示：机械刷洗远比棉球擦洗和氯己定冲洗效果好。The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine开设再培训课程强调口腔护理重要性，口腔护理真实执行情况。对于机械通气患者口腔护理，执行情况管理可以进一步研究。The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineICU护士护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？如何选择如何选择.？思考思考The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineICU护士护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？如何选择如何选择.？思考思考答案答案The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineICU护士口腔护理再培训口腔护理重要性VAP所起的作用再认识机械通气患者口腔护理方法选择口腔卫生评估口腔护理效果评价口腔护理执行管理再研究The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine将来的不久.会有新的认识.有新的选择.他们的口腔更健康.如同你我.谢谢大家蚌医一附院The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine