经气管插管拔出后患者的吞咽和口腔护理干预效果：一项干预前后研究。
Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study.
机构信息
Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
出版信息
Crit Care. 2019 Nov 9;23(1):350. doi: 10.1186/s13054-019-2623-2.
BACKGROUND
For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients' time to resume oral intake and salivary flow following endotracheal extubation.
METHODS
The sample comprised intensive care unit patients (≥ 50 years) successfully extubated after ≥ 48 h endotracheal intubation. Participants who received usual care (controls, n = 117) were recruited before 2015, and those who received usual care plus the intervention (n = 54) were enrolled after 2015. After extubation, all participants were assessed by a blinded nurse for daily intake status (21 days) and whole-mouth unstimulated salivary flow (2, 7, 14 days). The intervention group received the nurse-administered SOC intervention, comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education daily for 14 days or until hospital discharge.
RESULTS
The intervention group received 8.3 ± 4.2 days of SOC intervention, taking 15.4 min daily with no reported adverse event (coughing, wet voice, or decreased oxygen saturation) during and immediately after intervention. Participants who received the intervention were significantly more likely than controls to resume total oral intake after extubation (aHR 1.77, 95% CI 1.08-2.91). Stratified by age group, older participants (≥ 65 years) in the SOC group were 2.47-fold more likely than their younger counterparts to resume total oral intake (aHR 2.47, 95% CI 1.31-4.67). The SOC group also had significantly higher salivary flows 14 days following extubation (β = 0.67, 95% CI 0.29-1.06).
CONCLUSIONS
The nurse-administered SOC is safe and effective, with greater odds of patients' resuming total oral intake and increased salivary flows 14 days following endotracheal extubation. Age matters with SOC; it more effectively helped participants ≥ 65 years old resume total oral intake postextubation.
TRIAL REGISTRATION
NCT02334774, registered on January 08, 2015.
背景
对于从重症监护病房中幸存并拔除经口气管插管的患者，吞咽困难非常普遍，如果不进行干预，这种情况可能会在出院后持续很长时间。这项前瞻性和历史对照研究测试了吞咽和口腔护理（SOC）干预措施对气管拔管后患者恢复口服摄入和唾液流率的时间的影响。
方法
样本包括在气管插管≥48 小时后成功拔管的重症监护病房患者（≥50 岁）。接受常规护理（对照组，n=117）的参与者于 2015 年之前招募，接受常规护理加干预（n=54）的参与者于 2015 年之后招募。拔管后，由一名盲法护士对所有参与者进行每日摄入状况评估（21 天）和全口非刺激唾液流率评估（2、7、14 天）。干预组接受由护士实施的 SOC 干预，包括每天刷牙/唾液腺按摩、口腔运动练习和安全吞咽教育，持续 14 天或直至出院。
结果
干预组接受了 8.3±4.2 天的 SOC 干预，每天花费 15.4 分钟，干预期间和干预后立即无咳嗽、湿音或氧饱和度下降等不良事件报告。与对照组相比，接受干预的参与者更有可能在拔管后恢复总口服摄入（aHR 1.77，95%CI 1.08-2.91）。按年龄组分层，SOC 组中的老年参与者（≥65 岁）恢复总口服摄入的可能性是年轻参与者的 2.47 倍（aHR 2.47，95%CI 1.31-4.67）。拔管后 14 天，SOC 组的唾液流率也显著更高（β=0.67，95%CI 0.29-1.06）。
结论
由护士实施的 SOC 安全且有效，可增加患者恢复总口服摄入的可能性，并增加拔管后 14 天的唾液流率。年龄很重要，SOC 对≥65 岁的患者更有效，帮助他们在拔管后恢复总口服摄入。
试验注册
NCT02334774，于 2015 年 1 月 8 日注册。
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