The Effectiveness Of Oral Health Promotion On Pneumonia Complicating Stroke

Backgrounds: The World Health Organization(WHO)defines stroke as "a group of cerebrovascular diseases characterized by sudden onset and rapid onset of localized or diffuse brain dysfunction lasting more than 24 hours,which can cause organic brain injury or death".Its clinical types include ischemic stroke and hemorrhagic stroke.After stroke,approximately 85% of patients will develop functional dysfunction of the upper limbs in the acute phase,making oral self-health care difficult to implement.The prevalence of pneumonia complicating stroke,which is 20% to 60% in the acute phase of stroke,is the most difficult to treat with the worst prognosis,and the risk of death is three times higher than that of other stroke patients.Systematic use of antibiotics does not effectively prevent the occurrence of pneumonia complications.The opportunistic pathogens in oral cavity mainly include fungi,Staphylococcus aureus and aerobic/facultative anaerobic gram-negative bacilli.Existing literature found for oral opportunistic pathogens in patients with cerebral apoplexy carrying rate is higher than its carrying rate in the general population,and lung infection of immunocompromised populations stroke and alveolar lavage oral rinse sample some opportunistic pathogens in the distribution of the chromosome segments of DNA restriction enzyme pattern is similar.Therefore,a hypothesis was established to determine whether oral opportunistic pathogens were correlated with the occurrence of nosocomial pneumonia,ventilator associated pneumonia and other infections in non-stroke immunocompromised population.In this study,oral intervention measures were implemented in patients with acute stroke to control the types and relative abundance of oral opportunistic pathogens,so as to reduce the incidence of complications of stroke pneumonia.And a new generation of acer for sequencing technology is adopted to compare oral opportunity of pathogenic microorganisms and pneumonia complications pathogenic microorganism group diversity and similarity in species structure level,select the participation pneumonia complications of cerebral apoplexy oral pathogenic microorganism groups,for the correlation between oral opportunistic pathogens and stroke pneumonia complications provide direct evidence.Objectives: To determine whether oral health promotion has the value of routine inclusion in the comprehensive treatment of stroke:(1)at the clinical level,to determine whether oral health promotion can reduce the incidence of stroke pneumonia complications and improve the quality of life of stroke patients;(2)at the microbial level,the oral opportunistic pathogenic microbiome involved in the occurrence of pneumonia was selected to clarify the role of oral health promotion on its species and relative abundanceMethods: This study was a 6-month randomized,single-blind,parallel controlled trial of patients within 3 days of new stroke,with follow-up at 1,3,7 and 1,3,6 months after enrolment.After baseline assessment,each stroke patient pair and their family caregivers were randomly assigned to the intervention or control group in a 1:1 ratio.(1)Subjects in the intervention group were provided with electric toothbrush,0.2% chlorhexidine sodium gluconate mouthwash(10ml twice daily)and oral hygiene education(OHI)for 6months;(2)OHI was provided in the control group.A baseline oral health assessment(DMFT,PI,BOP,LOA)and a subjective health assessment(SF-12,OHIP,Gohai)were performed before randomization,and four follow-up assessments were performed at 1week,1 month,3 months,and 6 months after the implementation of the intervention.In addition,intensive oral gargle samples were collected from subjects without complications of stroke pneumonia at 1,3,5,and 7 days after admission during the patient’s hospitalization.For subjects with pneumonia complications,we collected sputum aspiration samples from the respiratory tract within 24 hours after the onset of pneumonia.Then,oral rinsing samples before pneumonia and samples of respiratory sputum aspiration after pneumonia from patients with complications of stroke pneumonia were matched.For stroke patients who had been discharged from the hospital one week after enrolment,it was no longer possible to obtain respiratory sputum aspiration samples within 24 hours after the occurrence of pneumonia,since most of the subjects had been discharged.However,we will continue to collect mouthwash samples from study subjects at one month,three months and six months after the intervention.Now the research of the relativity of oral opportunistic pathogens and pneumonia with traditional selective cultivation,16 s r RNA cloning sequencing technologies,as well as the technological pulsed field gel electrophoresis(PFGE)has certain subjectivity and limitation,can’t from pathogen level for the correlation between oral opportunistic pathogens and stroke pneumonia complications provide direct evidence,therefore the experiment adopts a new generation of acer for sequencing technology.It can provide us with the species structure(quantitative information of species and relative abundance of species in the environment)of all the bacterial communities in the sample.The sequencing results are accurate,which provides a new perspective for us to study the oral microorganisms related to disease.Results: A total of 98 subjects were recruited,17 were lost to follow-up,and 81 were still participating in the study a week later.Clinical and subjective oral health indicators and socio-demographic background were similar between the two groups at baseline(P BBB0 0.05).During this period,no patients developed aspiration pneumonia.There was no significant difference in alpha diversity between the two groups at each time point.Principal coordinate analysis(PCOA)showed that there was no significant separation of species composition between the two taxa over time.Streptococcus,Porphyromonas,Neisseria and Fusobacterium were the dominant species at all time points.Notably,the relative abundance of Enterobacteria,recognized as one of the pneumonia-associated respiratory pathogens,continued to decline in the intervention group,while it increased and peaked in the control group on day 5.Conclusion:Although aspiration pneumonia did not occur in the observed subjects,intensive sampling can be used to monitor dynamic changes in oral respiratory pathogens and provide evidence for the inclusion of oral health interventions in multidisciplinary stroke treatment.