The Effectiveness Of Perioperative Oral Care In Reducing Pulmonary Infection After Thoracic Surgery Surgery:systematic Review

Objective: To investigate the effectiveness of perioperative oral care of the rate of pulmonary infection,untoward effect,oral ulcer and mortality after thoracic surgical procedure.And to seek the the most effective method of Oral Care.Methods: Pub Med,Embase,Web of Science,Clinical Trials,CNKI,Wanfang,CQVIP,CBM and other databases were retrieved by computer and combined with manual retrieval until February 2021.The data was extracted and checked according to the inclusion criteria.Rev Man 5.3 and Addis software were used for statistical analysis.Results: Seventeen randomized controlled trials were included,of which 10 were cardiac surgical-related trials and 7 were general thoracic surgical-related trials.There were 3foreign literatures and 14 Chinese literatures,with a total of 4034 patients.There were 10 interventions in 14 control protocols.These included chlorhexidine,povidone iodine,chloramine,furacillin,hydrogen peroxide,listerine,enhanced oral care,normal saline,placebo,and negative controls.The results of meta-analysis showed that: compared with the control group,perioperative oral care showed statistically significant differences in the overall incidence of pulmonary infection,incidence of premature ventilator associated pneumonia,and incidence of oral ulcer after thoracic surgery(P<0.05).However,there was no significant difference in the incidence of late-onset ventilator-associated pneumonia or postoperative mortality(P>0.05).The incidence of untoward effect in oral care has not been mentioned in any literature.Also the differences in mechanical oral care in bayes-analysis were statistically significant for all interventions except povidone iodine and hydrogen peroxide.Conclusion: Perioperative oral care can reduce the incidence of postoperative pulmonary infection,premature ventilator-associated pneumonia and oral ulcer in patients undergoing thoracic and cardiac surgery.Among them,the effect of cardiac surgery and general thoracic surgery is similar,and the effect of patients under 60 years old is more obvious than that of patients 60 and older,the effect of Chinese patients is more obvious than that of foreign patients.But there is no significant effect on late-onset ventilator-associated pneumonia and postoperative mortality.Also among all positive interventions for the prevention of postoperative pulmonary infection,mechanical oral care(i.e.intensive oral care)might be the most effective.However,for patients with oral ulcer,a gargle containing antiseptic ingredients such as povidone iodine or chlorhexidine may provide a better overall effect.