泡沫拭子与牙刷作为机械通气患者口腔卫生干预措施的比较：一项随机分口研究。

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study.

作者信息

Marino Paola J, Hannigan Ailish, Haywood Sean, Cole Jade M, Palmer Nicki, Emanuel Charlotte, Kinsella Tracey, Lewis Michael A O, Wise Matt P, Williams David W

机构信息

School of Dentistry, Cardiff University , Cardiff , UK.

Graduate Entry Medical School, University of Limerick , Limerick , Ireland.

出版信息

BMJ Open Respir Res. 2016 Oct 14;3(1):e000150. doi: 10.1136/bmjresp-2016-000150. eCollection 2016.

DOI:10.1136/bmjresp-2016-000150

PMID:27843549

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5073587/

Abstract

INTRODUCTION

During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients.

METHODS

This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts.

RESULTS

High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=-1.26, 95% CI -1.57 to -0.95; p<0.001) and foam swabs (mean change=-1.28, 95% CI -1.54 to -1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=-0.92; 95% CI -1.19 to -0.64; p<0.001) and foam swabs (mean change=-0.85; 95% CI -1.10 to -0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×10 colony-forming units (CFUs); minimum to maximum (-2.5×10 CFUs, 8.7×10 CFUs)) and foam swabs (mean change 9×10 CFUs; minimum to maximum (-3.1×10 CFUs, 3.0×10 CFUs)).

CONCLUSIONS

Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation.

TRIAL REGISTRATION NUMBER

NCT01154257; Pre-results.

摘要

引言

在危重病期间，牙菌斑可能成为呼吸道病原体的储存库。本研究比较了在机械通气患者中使用小头牙刷或泡沫头拭子刷牙的效果。

方法

这是一项在单一重症监护病房进行的随机、评估者盲法、分口试验。纳入预期机械通气时间>24小时、有>20颗牙齿的成年经口插管患者。使用泡沫拭子或牙刷（各随机分配至口腔一侧）每12小时清洁一次牙齿。清洁效果基于菌斑评分、牙龈指数和微生物菌斑计数。

结果

21例患者的初始菌斑（平均=2.1（标准差0.45））和牙龈（平均=2.0（标准差0.54））评分较高。使用牙刷（平均变化=-1.26，95%置信区间-1.57至-0.95；p<0.001）和泡沫拭子（平均变化=-1.28，95%置信区间-1.54至-1.01；p<0.001）后，与初始菌斑指数相比均有显著降低。随着时间推移，使用牙刷（平均变化=-0.92；95%置信区间-1.19至-0.64；p<0.001）和泡沫拭子（平均变化=-0.85；95%置信区间-1.10至-0.61；p<0.001）后牙龈指数均有显著降低。清洁方法之间的差异无统计学意义（牙龈指数变化p=0.12；菌斑指数变化p=0.24）。刷牙（平均变化3.7×10菌落形成单位（CFU）；最小至最大（-2.5×10 CFU，8.7×10 CFU））和泡沫拭子（平均变化9×10 CFU；最小至最大（-3.1×10 CFU，3.0×10 CFU））之间的细菌牙菌斑计数无显著变化。