Study On The First Oral Care Time For The Patients With Unplanned Intubation

Objective:Recent years, there is more and more attention to the relationship between the patients who receive tracheal intubation and the Ventilator-associated pneumonia. The dental plaque has always been a hot issue of research in recent years. The bacterial dental plaque is a dynamic and complex system that associates microorganisms and an extracellular matrix. The economical method of clearing or inhibiting the growth of plaque simple is oral care. Nowadays, the studies of the first time oral care for the emergency unplanned intubation of patients are less. Some abroad scholars have suggested that the first time oral care time should be within12hours after intubation implemented, but some scholars have suggested the effective oral care time should be preferably carried out immediately after intubation. For that, it has not been clearly defined. Given that, this paper aims at exploring the suitable time for the first time oral care of patients who have the emergency unplanned intubation as well as the related factors.Methods:The random sample from the patients received unplanned intubation in the emergency room from December2012to July2013. We scored the patients’dental plaque and took the sample from the dental plaque to make bacterial culture at the time the patients received unplanned intubation, the6th,8th,1Oth and12th hour. The amount of dental plaque was assessed by a score modified from the semiquantitative plaque index described by Silness and Loe. The samples of plaque were collected from the third tooth surface with sterile swab tube. Each tube was immersed in0.5ml buffer solution then was immediately transported to the laboratory, vortexed for5mins, and discarded0.3ml buffer solution. Then the sample was plated on blood-enriched agar and aerobically cultured at37. After48hrs, the variety of the bacteria was been observed and the growth was recorded by Semi-quantitative indicators (a few,(+),(++).(+++)). The groups of the first64patients who are collected prior are defined as a control group. After the last sampling time, take the oral care immediately to ensure the completion of the oral care within12h after intubation. The results will be analyzed and the statistical factors may also be analyzed, then based on the results of the control group, the following collected171patients were randomly divided into three groups, namely A, B and group C, as well as taking samples at6,8and10hours after intubation oral care intervention, other score and sample are consistent with the control group.Results:1. The score and the growth of bacteria from the beginning to the6th hour is the greatest difference (P<0.01). And the bacterial species is streptococcus viridans in most patients’dental plaque, except there are11patients occurring Acinebacter baumannii (Ab), Staphylococcus epidermidis, Staphylococcus haemolyticus (S.haemohyticus), Klebsiella pneumoninae (KPN). There is barely relevance about the scores, the bacterial culture and the sex, the age. The smoking history (P<0.05in the10th and12th) and the surgery has faint influence in these results (P<0.05in the6th,10th and12th). And the dwelling environments influence these results obviously (0.01<P<0.05)2. In the12th, three experimental groups was no significant difference scores (P>0.05), comparing the scores of the three experimental groups after oral care2hours, Group B is less than the other two groups(P<0.01)3. In the12th, Group C is less than the other two groups(P<0.05). Comparing the growth of bacteria of the three experimental groups after oral care2hours, Group B is less than the other two groups(P<0.05)Conclusion:1. The dental plaque score and the growth of bacteria in plaque increase with time after emergency tracheal intubation,with the highest increase occurring in the first6h, then in the next2h.2. From the look of plaque score in the first eight hours of oral care intervention in inhibiting plaque growth is superior to the6th and10th hour’s intervention. From the look of the growth of bacteria in the8th hour of oral care intervention in inhibiting bacteria growth is superior to the6th and10th hour intervention. Combining with the work burden of the nurses, the first oral care in the8th hour may receive the better outcome.3. The start time for oral care should be as early as possible for patients receiving surgery, with smoking history, and living in rural areas.