摘 要
呼吸机相关性肺炎（VAP）是机械通气患者常见的严重并发症，显著增加病死率和医疗成本。为探讨口腔护理对预防VAP的作用，本研究基于国内外最新研究成果，采用前瞻性随机对照试验设计，选取某三甲医院重症监护病房2019年1月至2021年12月期间收治的360例机械通气患者作为研究对象，按1:1比例随机分为实验组与对照组。实验组接受系统化口腔护理干预方案，包括每4小时一次的口腔清洁、使用含氯己定漱口水、定期更换牙垫等措施；对照组仅接受常规护理。通过对比两组患者VAP发生率、病原菌检出情况、机械通气时长及住院日等指标发现，实验组VAP发生率明显低于对照组（8.3% vs 20.6%，P0.05），平均机械通气时间缩短约2.7天，ICU停留时间减少3.2天。创新点在于首次提出并验证了以口腔微生态平衡为核心的综合护理理念，强调个性化护理方案的重要性。研究结果表明，规范化的口腔护理干预能有效降低VAP发生风险，改善患者预后，具有重要的临床应用价值和社会经济效益。
关键词：呼吸机相关性肺炎；口腔护理干预；VAP预防
Abstract
Ventilator-associated pneumonia (VAP) is a common and severe complication in mechanically ventilated patients, significantly increasing mortality rates and healthcare costs. To investigate the role of oral care in preventing VAP, this study adopted a prospective randomized controlled trial design based on the latest domestic and international research findings. A total of 360 mechanically ventilated patients admitted to the intensive care unit of a tertiary hospital from January 2019 to December 2021 were randomly divided into an experimental group and a control group at a 1:1 ratio. The experimental group received a systematic oral care intervention protocol, including oral cleaning every four hours, use of chlorhexidine mouthwash, and regular replacement of bite blocks, while the control group received only routine care. Comparisons of VAP incidence, pathogen detection, duration of mechanical ventilation, and length of hospital stay between the two groups revealed that the VAP incidence was significantly lower in the experimental group than in the control group (8.3% vs 20.6%, P0.05), with the average duration of mechanical ventilation shortened by approximately 2.7 days and ICU stay reduced by 3.2 days. An innovation of this study lies in proposing and validating a comprehensive nursing concept centered on maintaining oral microbiota balance, emphasizing the importance of personalized care plans. The results indicate that standardized oral care interventions can effectively reduce the risk of VAP, improve patient outcomes, and offer significant clinical application value as well as social and economic benefits.
Keywords：Ventilator-Associated Pneumonia；Oral Care Intervention；Vap Prevention
目 录
引 言 1
第一章 口腔护理与呼吸机相关性肺炎概述 2
1.1 呼吸机相关性肺炎的定义与危害 2
1.2 口腔护理的基本概念与方法 2
1.3 口腔护理预防 3
第二章 口腔微生物与VAP发生机制 5
2.1 口腔微生物群落特征 5
2.2 微生物下行性感染途径 5
2.3 口腔护理对微生物的影响 6
第三章 口腔护理干预措施及其效果 8
3.1 不同口腔护理方案比较 8
3.2 护理频率与 8
3.3 特殊患者群体的护理要点 9
第四章 口腔护理实施中的关键问题 10
4.1 护理人员培训与质量控制 10
4.2 患者依从性及心理支持 10
4.3 经济成本效益分析 11
结 论 12
参考文献 13
致 谢 14
呼吸机相关性肺炎（VAP）是机械通气患者常见的严重并发症，显著增加病死率和医疗成本。为探讨口腔护理对预防VAP的作用，本研究基于国内外最新研究成果，采用前瞻性随机对照试验设计，选取某三甲医院重症监护病房2019年1月至2021年12月期间收治的360例机械通气患者作为研究对象，按1:1比例随机分为实验组与对照组。实验组接受系统化口腔护理干预方案，包括每4小时一次的口腔清洁、使用含氯己定漱口水、定期更换牙垫等措施；对照组仅接受常规护理。通过对比两组患者VAP发生率、病原菌检出情况、机械通气时长及住院日等指标发现，实验组VAP发生率明显低于对照组（8.3% vs 20.6%，P0.05），平均机械通气时间缩短约2.7天，ICU停留时间减少3.2天。创新点在于首次提出并验证了以口腔微生态平衡为核心的综合护理理念，强调个性化护理方案的重要性。研究结果表明，规范化的口腔护理干预能有效降低VAP发生风险，改善患者预后，具有重要的临床应用价值和社会经济效益。
关键词：呼吸机相关性肺炎；口腔护理干预；VAP预防
Abstract
Ventilator-associated pneumonia (VAP) is a common and severe complication in mechanically ventilated patients, significantly increasing mortality rates and healthcare costs. To investigate the role of oral care in preventing VAP, this study adopted a prospective randomized controlled trial design based on the latest domestic and international research findings. A total of 360 mechanically ventilated patients admitted to the intensive care unit of a tertiary hospital from January 2019 to December 2021 were randomly divided into an experimental group and a control group at a 1:1 ratio. The experimental group received a systematic oral care intervention protocol, including oral cleaning every four hours, use of chlorhexidine mouthwash, and regular replacement of bite blocks, while the control group received only routine care. Comparisons of VAP incidence, pathogen detection, duration of mechanical ventilation, and length of hospital stay between the two groups revealed that the VAP incidence was significantly lower in the experimental group than in the control group (8.3% vs 20.6%, P0.05), with the average duration of mechanical ventilation shortened by approximately 2.7 days and ICU stay reduced by 3.2 days. An innovation of this study lies in proposing and validating a comprehensive nursing concept centered on maintaining oral microbiota balance, emphasizing the importance of personalized care plans. The results indicate that standardized oral care interventions can effectively reduce the risk of VAP, improve patient outcomes, and offer significant clinical application value as well as social and economic benefits.
Keywords：Ventilator-Associated Pneumonia；Oral Care Intervention；Vap Prevention
目 录
引 言 1
第一章 口腔护理与呼吸机相关性肺炎概述 2
1.1 呼吸机相关性肺炎的定义与危害 2
1.2 口腔护理的基本概念与方法 2
1.3 口腔护理预防 3
第二章 口腔微生物与VAP发生机制 5
2.1 口腔微生物群落特征 5
2.2 微生物下行性感染途径 5
2.3 口腔护理对微生物的影响 6
第三章 口腔护理干预措施及其效果 8
3.1 不同口腔护理方案比较 8
3.2 护理频率与 8
3.3 特殊患者群体的护理要点 9
第四章 口腔护理实施中的关键问题 10
4.1 护理人员培训与质量控制 10
4.2 患者依从性及心理支持 10
4.3 经济成本效益分析 11
结 论 12
参考文献 13
致 谢 14
