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1、口腔护理,蚌医一附院 重症医学科,ICU护士新认识,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,你、我、他 每个人. 每天,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,一般患者.,ICU患者.,口腔护理,口腔护理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,方法一
2、样吗.?,达到效果一样吗.?,The 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.,The 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
3、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,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 Bengbu Medical College in intensive medicine,口咽部分泌物的吸入是VAP发生的最主要途径,J Bras Pne
4、umol. 2008;34(9):707-714,The 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 medicine,AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2010, Volume 19, No. 2,显示：50%的护士认为每2小时一次口腔护理，42%的护士认
5、为每4小时一次口腔护理,The 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 medicine,生理盐水 稀释碘伏溶液 稀释碳酸氢钠 氯己定漱口液 ,The
6、 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 ,q12h q8h q6h q4h q2h,The 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 ,q12h q8h q6h q4h q2h,刷、冲、洗、冲洗、冲刷,牙刷、棉球、纱布块,The First Affiliated Hospital
7、 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 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 medicine,ICU护士： 口腔卫生评估？ 护理效果评价？ 口腔护理再培训 ？
8、 口腔护理执行管理？,如何选择？,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,ICU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？,思考,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,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
9、腔卫生非常有助于预防VAP发生。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,目的：通过研究来评价ICU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 medicine,53名,学历,ICU工作时间,雇佣形式,53名护士基本情况,The First Affiliated Hospital of Bengbu Medical College in i
10、ntensive 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 medicine,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 medicine,关于列出的十个日常护理规程，每个护理规程进
11、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 medicine,10项日常护理规程得分平均值和标准差,气管管理,口腔护理,皮肤护理,营养护理,导管维护,个人卫生,眼部护理,预防机体超负荷,记录单书写,肠道功能护理,The 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
12、腔护理时使用的频次越高,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,12种口腔护理材料和工具使用频次,纱布块,氯己定,生理盐水,口腔冲洗,The 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 Colle
13、ge in intensive medicine,护士进行口腔护理障碍原因,人员不足,时间缺乏,担负书写任务,害怕感染转移,缺乏设备,气管插管存在,不重要,缺乏知识和能力,害怕吸引,不愉快,和我没关系,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,53名,学历,ICU工作时间,雇佣形式,53名护士基本情况,理学士,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,机械通气患者提出护
14、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 medicine,10项日常护理规程得分平均值和标准差,气管管理,口腔护理,皮肤护理,营养护理,导管维护,个人卫生,眼部护理,预防机体超负荷,记录单书写,肠道功能护理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,12种口腔护理材料和工具使用频次,纱布块,氯己定,生理盐水
15、,口腔冲洗,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,护士进行口腔护理障碍原因,人员不足,时间缺乏,担负书写任务,害怕感染转移,缺乏设备,气管插管存在,不重要,缺乏知识和能力,害怕吸引,不愉快,和我没关系,The 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 Fir
16、st 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 medicine,47%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 medicine,有必要进行护士口腔护理再培训以及
