成人加護病房病患疾病嚴重度與口腔狀況相關性之探討

A study of the relationship between oral status and disease severity among Adult lntensive care unit patients

陳筱蓉(Hsiao-Rong Chen)

指導教授 ： 謝天渝

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00006

摘要

中文摘要
研究背景：
當病人APACHE II分數越高其所表示病情越不穩定，而口腔健康狀況是否會隨病情的進展而有所改變，在國內並未曾被討論過。目前加護單位針對口腔健康狀況，並未有發展出整體性、適當性的口腔評估量表，更引發研究者的動機。
研究目的：
瞭解加護病房病患口腔健康狀況與病患個人特徵、疾病嚴重程度
及口腔照護情形之相關性。
研究方法：
本研究對象共129名，採用橫斷式相關性(cross-sectional correlational study)研究設計，以方便取樣(convenience sampling)。研究對象篩選條件為：（1）在加護病房住滿24小時病患。（2）無牙關緊閉者（3）插氣管內管無併有Bite留置者。（4）徵得病患或家屬同意，並簽署同意書，均列入研究對象來源。病患基本資料表、APACHE II評分表、口腔黏膜檢查表、加護病房口腔護理執行紀錄表。資料庫使用Excel，資料分析使用JMP 5.12軟體。
研究結果：
經由線性迴歸分析結果顯示，加護病房病患有罹患慢性疾病史、年齡愈大、教育程度愈低、牙菌斑指數愈高，其疾病嚴重度分數愈多。有行氣管造口、年齡愈大、教育程度愈低，牙菌斑指數愈高；女性牙菌斑指數高於男性。有氣管內管留置、有義齒補綴狀況、年齡愈大、教育程度愈低、牙菌斑指數愈高，口腔黏膜潰瘍機率愈高。
結論：
整體而言，加護單位病患口腔狀況主要問題為牙菌斑，而牙菌
斑指數在牙科疾病的預防與治療策略，是個重要指標。目前加護病房
缺乏口腔清潔評估工具，牙菌斑指數檢查在臨床執行上操作簡便，應
可列為加護單位病患口腔清潔照護之重要指標。可在護理系開設口腔
照護相關學門，以提昇護理系學生之認知。中老年人之口腔健康狀
況較差，可在醫院牙科門診內設立中老年人口腔衛生教育方案。並推
動社區中老年人口腔衛生保健預防觀念，及倡導民眾養誠定期口腔檢
查習慣。

關鍵字

牙菌斑 ； 口腔衛生 ； 口腔評估 ； 口腔健康 ； 加護病房

並列摘要

Abstract

Introduction:

When a patient has a higher score on the APACHE II, it means that the condition is unstable. However, in this country, there hasn’t been any research conducted yet on whether or not oral health will change as the condition progresses. As of today, the intensive care unit has by no means developed the means, technique or suitable oral assessment chart; thus providing, the researcher’s motive.

Purpose:

To understand patient’s oral health conditions, individual characteristics, the degree of seriousness of the diseases, as well as oral care- related situations in the intensive care unit.

Method:

This research was conducted based on cross-sectional correlational study and convenience sampling from 129 subjects. The subjects’ requirements for inclusion in the study are as follows: (1) admitted to the intensive care unit for at least 24 hours; (2) does not have tightly closed teeth; (3) has inner endotracheal tube without bite; (4) give consent by the patient or patient’s family. Furthermore, patient’s history, APACHE II, oral mucous membrane exam sheet, and intensive care unit record were also required. The information was recorded using Excel and JMP 5.12 software was used for data analysis.

Results:

From JMP Logistic Regression data analysis, it was observed that intensive care unit patients who had history of chronic disease, older age, lower level of education, had higher plaque index as well as higher scores on seriousness of disease. Patients who had tracheotomy with older age and lower level of education also had higher plaque index. Women tended to have higher plaque index than men. The probability of oral hygiene problems was higher with endo tracheal , tube , denture restoration, older age, lower level of education and higher plaque index factoes.

Conclusion:

In sum, the main oral cavity concern for the patients in intensive care unit is the plaque accumulation. Currently, the prevention and treatment strategy for plaque accumulation is an important target in dental disease health care. The lack of oral hygiene measuring device and plaque index inspection in the intensive care unit should be the primary target for oral health care for intensive care unit patients. In addition, education on oral care should be improved in nursing school to promote students’ knowledge. Furthermore, oral hygiene education should be provided by the hospital dental outpatient service for those who needit. There should also be a (local government-sponsored) movement for the oral hygiene care prevention idea for the middle-old-aged person in the community , as well as getting them to be accustomed to have dental inspections regularly.

並列關鍵字

Plaque Index ； Oral Hygiene ； Oral Assessment ； Oral Health ； Intensive Care Unit

參考文獻

參考文獻

1.王淑梅、林宛蓉、郭碧淇。提升化學治療之護理指導專案。腫瘤護

理雜誌2005；5：63-75。

2.湯澡薰、楊哲銘、荘淇源、張明利、黃玉純、黃錦鳳等。台灣地區加護病房臨床嚴重度評估系統應用之比較研究。慈濟醫學雜誌2005；17：239-245。

3.周志銜、何清松、邱耀章、藍守仁、陳俊凱、劉育能等。嘉義市國