脑卒中患者口腔健康管理的最佳证据总结

doi:10.16460/j.issn1008-9969.2022.09.036

摘要/Abstract

摘要： 目的总结脑卒中患者口腔健康的最佳证据,为临床实践提供依据。方法计算机检索BMJ Best Practice、美国国立指南库、加拿大安大略注册护士协会、国际指南协作网、苏格兰院际指南网、Cochrane Library、JBI循证卫生保健中心数据库、英国国家卫生与临床优化研究所、PubMed、中国知网、CBM、万方数据库的所有关于脑卒中患者口腔健康管理的证据,包括最佳实践信息册、临床决策、指南、系统评价、证据总结、专家共识,检索从建库至2021年6月8日。按照纳入排除标准进行筛选,由2名研究者进行独立评价,依据专家意见提取并综合证据。结果共纳入10篇文献,其中8篇指南,2篇系统评价,从组织团队、培训教育、计划与评估、实施、特殊患者、健康宣教6个方面总结出20条脑卒中患者口腔健康管理的最佳证据。结论临床实践中医务人员需加强口腔健康管理知识的教育培训,通过跨专业团队为患者制定口腔护理计划,动态评估患者口腔健康状况,把握口腔护理实施的时机和频率,为患者选择合适的口腔护理用具,加强特殊患者的口腔健康管理,为脑卒中患者及其照护者提供口腔健康信息支持。需结合具体临床判断及需求,有指向性地选择证据,以促进最佳证据在脑卒中患者口腔健康管理中的应用。

关键词: 脑卒中, 口腔健康, 循证护理, 证据总结

Abstract: Objective To summarize the best evidence of oral health management for stroke patients, and provide reference for clinical practice. Methods We systematically searched websites of BMJ Best Practice, National Guideline Clearinghouse（NGC）, Registered Nurses Association of Ontario（RNAO）,Guidelines International Network（GIN）, Scottish Intercollegiate Guidelines Network（SIGN）, Cochrane Library, Joanna Briggs Institute（JBI）, National Institute for Health and Care Excellence（NICE）, PubMed, CNKI, CBM and Wanfang for best practice information, clinical decision support, guideline, systematic review, evidence summary, expert consensus from the inception to 8, June 2021. Screening was conducted according to the inclusion and exclusion criteria, and independent evaluation was conducted by two researchers. Evidence was extracted and synthesized according to expert opinions. Results Ten pieces of literature were collected, including 8 guidelines and 2 systematic reviews. Twenty pieces of best evidence of oral health management for stroke patients were summarized from 6 aspects of team organization, training and education, planning and evaluation, implementation, special patients and health education. Conclusion In clinical practice, medical staff need to strengthen the education and training of oral health management knowledge, Oral care plans for patients through a multi-professional team, dynamic evaluation of patients' oral health, the timing and frequency of oral care, appropriate oral care appliances for patients, oral health management of special patients, and oral health information support for stroke patients and their caregivers should be considered. Evidence should be selected according to specific clinical judgment and needs, so as to promote the application of the best evidence in oral health management of stroke patients.

Key words: stroke, oral health, evidence-based nursing, evidence summary

中图分类号:

R473.54

李翔, 冯英璞, 孟晓静, 周立民, 霍晓冉, 许梦敏, 王昊. 脑卒中患者口腔健康管理的最佳证据总结[J]. 护理学报, 2022, 29(9): 36-41.

LI Xiang, FENG Ying-pu, MENG Xiao-jing, ZHOU Li-min, HUO Xiao-ran, XU Meng-min, WANG Hao. Best Evidence Summary of Oral Health Management for Stroke Patients[J]. Journal of Nursing, 2022, 29(9): 36-41.

参考文献

[1] Zeng LN, Rao WW, Luo SH, et al.Oral Health in Patients with Stroke:A Meta-analysis of Comparative Studies[J]. Top Stroke Rehabil,2020, 27(1):75-80.DOI:10.1080/10749357.2019.1656413.
[2] 朱慈燕,韩辉.口腔疾病与脑血管病的关系[J].临床与病理杂志,2020, 40(12):3313-3316.DOI:10.3978/j.issn.2095-6959.2020.12.036.
[3] Prendergast V, Hinkle JL.Oral Care Assessment Tools and Interventions after Stroke[J]. Stroke,2018,49(4):153-156. DOI:10.1161/STROKEAHA.117.017045.
[4] Campbell P, Bain B, Furlanetto DL, et al.Interventions for Improving Oral Health in People after Stroke[J]. Cochrane Database of Systematic Reviews,2020,12(3):1-124. DOI:10.1002/14651858.CD003864.pub3.
[5] Maarel-WC, Vano Bb, Bronkhorst EM, et al.Oral Health Care and Aspiration Pneumonia in Frail Older People: A Systematic Literature Review[J]. Gerodontology, 2013,30(1):3-9. DOI:10.1111/j.1741-2358.2012.00637.x.
[6] Bijani B, Mozhdehipanah H, Jahanihashemi H, et al.The Impact of Pneumonia on Hospital Stay Among Patients Hospitalized for Acute Stroke[J]. Neurosciences, 2014, 19(2):118-123.
[7] Wilson RD.Mortality and Cost of Pneumonia after Stroke for Different Risk Groups[J]. J Stroke Cerebrovasc Dis, 2012,21(1):61-67. DOI:10.1016/j.jstrokecerebrovasdis.2010.05.002.
[8] Ajwani S,Jayanti S,Burkolter N,et al.Integrated Oral Health Care for Stroke Patients-a Scoping Review[J]. J Clin Nurs, 2017,26(7/8):891-901. DOI:10.1111/jocn.13520.
[9] National Stroke Foundation. Clinical guidelines for stroke management[EB/OL].(2019-12-01)[2021-06-08].https://strokefoundation.com.au/what-we-do/treatment-programs/clinical-guidelines.
[10] Hebert D, Lindsay MP, Mcintyre A, et al.Canadian Stroke Best Practice Recommendations:Stroke Rehabilitation Practice Guidelines, Update 2015[J]. Int J Stroke,2016,11(4):459-484. DOI:10.1111/ijs.12557.
[11] 吴秋月,蒋艳.脑卒中病人口腔健康管理的研究进展[J].护理研究,2021, 35(1):93-98. DOI:10.12102/j.issn.1009-6493.2021.01.016.
[12] 朱政,胡雁,周英凤,等.推动证据向临床转化(三)研究的选题和问题构建[J].护士进修杂志, 2020,35(9):796-799. DOI:10.16821/j.cnki.hsjx.2020.09.008.
[13] 严玉娇,丁娟,刘晁含,等.成人危重症患者气道管理的最佳证据总结[J].护理学报,2021,28(3):39-45. DOI:10.16460/j.issn1008-9969.2021.03.039.
[14] 王亚玲,王冰寒,张艳,等.急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结[J].护理学报,2021,28(3):46-52. DOI: 10.16460/j.issn1008-9969.2021.03.046.
[15] 林茂,曾力楠,李佳莲,等.全球指南临床适用性评价工具现状的系统评价[J].中国循证医学杂志, 2020,20(4):437-443. DOI: 10.7507/1672-2531.201904132.
[16] 陶欢,杨乐天,平安,等.随机或非随机防治性研究系统评价的质量评价工具AMSTAR 2解读[J].中国循证医学杂志,2018,18(1):101-108. DOI:10.7507/1672-2531.201711005.
[17] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[18] 邢唯杰,胡雁,周英凤,等.推动证据向临床转化(六)证据总结的制作与撰写[J].护士进修杂志,2020,35(12):1129-1132. DOI:10.16821/j.cnki.hsjx.2020.12.016.
[19] 朱政,胡雁,周英凤,等.推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J].护士进修杂志,2020,35(11):996-1000. DOI:10.16821/j.cnki.hsjx.2020.11.009.
[20] Campbell P, Bain B, Furlanetto D L, et al. Interventions for Improving Oral Health in People after Stroke[EB/OL].(2020-12-07)[2021-06-08]. https://doi.org/10.1002/14651858.CD003864.pub3.
[21] Registered Nurses’ Association of Ontario(RNAO). Oral Health: Supporting Adults Who Require Assistance, Second Edition. [EB/OL].(2020-05-15)/[2021-06-08].https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_
Adults_Who_ Require_Assistance_Second_Edition_FINAL_WEB_Dec_2020.pdf.
[22] Scottish Intercollegiate Guidelines Network(SIGN). Management of Patients with Stroke: Identification and Management of Dysphagia[EB/OL].[2021-06-08].https://www.sign.ac.uk/media/1057/sign119.pdf.
[23] Scottish Intercollegiate Guidelines Network(SIGN). Management of Patients with Stroke: Rehabilitation,Prevention and Management of Complications, and Discharge Planning.[EB/OL].[2021-06-08].https://www.sign.ac.uk/media/1056/sign118.pdf.
[24] National Institute for Health and Care Excellence(NICE). Guidelines for the Oral Healthcare of Stroke Survivors [EB/OL].[2021-06-08]. https://www.gerodontology.com/content/uploads/2014/10/stroke_guidelines.pdf.
[25] National Institute for Health and Care Excellence(NICE). Management of Long Term Complications of Stroke and TIA Stroke[EB/OL].[2021-06-08]. https://cks.nice.org.uk/topics/stroke-tia/management/secondary-prevention-following-stroke-tia/.
[26] National Institute for Health and Care Excellence(NICE). Stroke Rehabilitation in Adults[EB/OL].[2021-06-08] https://nice.org.uk/guidance/cg162.
[27] Boulanger JM, Lindsay MP, Gubitz G, et al.Canadian Stroke Best Practice Recommendations for Acute Stroke Mana-gement: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018[J]. Int J Stroke,2018,13(9):949-984.DOI:10.1177/1747493018786616.
[28] Kothari M, Pillai RS, Kothari SF, et al.Oral Health Status in Patients with Acquired Brain Injury: A Systematic Review[J]. Oral Surg Oral Med Oral Pathol Oral Radiol,2017,123(2):205-219. DOI: 10.1016/j.oooo.2016.10.024.
[29] National Institute for Health and Care Excellence(NICE). National Clinical Guideline for Stroke Prepared by the Intercollegiate Stroke Working Party[EB/OL].[2021-06-08]https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx.
[30] Binkley CJ, Johnson KW, Abadi M, et al.Improving the Oral Health of Residents with Intellectual and Developmental Disabilities: An Oral Health Strategy and Pilot Study[J].Eval Program Plann,2014,47:54-63.DOI:10.1016/j.evalprogplan.2014.07.003.
[31] Samson H, Berven L, Strand GV.Long-term Effect of an Oral Healthcare Programme on Oral Hygiene in a Nursing Home[J]. Eur J Oral Sci, 2009,117(5):575-579. DOI:10.1111/j.1600-0722.2009.00673.x.
[32] Yu P, Fu Q, Shi J, et al.Effects of Different Levels of Caregiver Training on Oral Hygiene after Stroke[J]. J Am Geriatr Soc,2016,64(6):1335-1340. DOI:10.1111/jgs.14143.[33] 温淼淼,赵梅珍,曾铁英.我国27所医院经气管插管患者口腔护理操作流程的内容分析[J].护理学杂志,2016,31(8):42-47. DOI10.3870/j.issn.1001-4152.2016.08.043.
[34] 曹艳佩,杨晓莉,唐慧婷,等.气管插管危重患者口腔护理的循证实践[J].护理学杂志,2016,31(11):45-48. DOI:10.3870/j.issn.1001-4152.2016.11.045.
[35] Malik N, Mohamad YS, Lam OL, et al.Effectiveness of a Web-based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial[J].J Med Internet Res, 2017,19(3):e87. DOI: 10.2196/jmir.7024.
[36] Brady M, Furlanetto D, Hunter RV, et al. Staff-led Interventions for Improving Oral Hygiene in Patients Foll-Owing Stroke[J]. The Cochrane Database of Systematic Reviews,2006(4):Cd003864.DOI:10.1002/14651858.CD003864.pub2.
[37] Robertson T, Clarke D.Oral Intensity: Reducing Non-ventilator-associated Hospital-acquired Pneumonia in Care-dependent Neurologically Impaired Patients[J]. Can J Neurosci Nurs,2013,35(2):10-17.
[38] Prendergast V, Kleiman C, King M.The Bedside Oral Exam and the Barrow Oral Care Protocol:Translating Evidence-based Oral Care Into Practice[J].Intensive Crit Care Nurs,2013,29:282-290. DOI:10.1016/j.iccn.2013.04.001.
[39] Haghighi A, Shafipour V, Bagheri-Nesami M, et al.The Impact Of Oral Care on Oral Health Status and Prevention of Ventilator-associated Pneumonia in Critically Ill Patients[J]. Aus Crit Care,2017,30(2):69-73. DOI:10.1016/j.aucc.2016.07.002.
[40] Pradhan A,Keuskamp D, Brennan D.Pre- and Post-Training Evaluation of Dental Efficacy and Activation Measures in Carers of Adults with Disabilities in South Australia-a Pilot Study[J]. Health Soc Care Community, 2016,24(6):739-746. DOI:10.1111/hsc.12254.
[41] 张绮,谢蟪旭,何瑶,等.国内部分三甲医院危重疾病患者口腔护理情况调查[J].中国循证医学杂志,2010,10(6):665-669. DOI: 10.3969/j.issn.1672-2531.2010.06.011.
[42] 王梦,靳艳,王昊,等.脑卒中患者口腔卫生现状与干预研究进展[J].中国老年保健医学,2021,19(2):100-103. DOI:10.3969/j.issn.1672-2671.2021.02.032.
[43] Kim EK,Jang SH,Choi YH,et al.Effect of an Oral Hygienic Care Program for Stroke Patients in the Intensive Care Unit[J]. Yonsei Medical Journal, 2014, 55(1):240-246. DOI:10.3349/ymj.2014.55.1.240.
[44] Prendergast V, Jakobsson U, Renvert S, et al.Effects of a Standard Versus Comprehensive Oral Care Pro-tocol Among Intubated Neuroscience ICU Patients:Results of a Randomized Controlled Trial[J].J Neurosci Nurs, 2012, 44(3):134-146. DOI:10.1097/JNN.0b013e3182510688.
[45] Cohn JL, Fulton JS.Nursing Staff Perspectives on Oral Care for Neuroscience Patients[J].J Neurosci Nurs, 2006,38(1):22-30. DOI:10.1097/01376517-200602000-00006.

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