MEKANİK VENTİLATÖR DESTEĞİNDEKİ HASTALARA İKİ FARKLI YÖNTEMLE VERİLEN AĞIZ BAKIMININ ORAL MUKOZADAKİ BAKTERİYEL KOLONİZASYON VE AĞIZ SAĞLIĞI ÜZERİNE ETKİSİ

Öz

Amaç: Mekanik ventilatör desteğindeki hastalarda iki farklı yöntemle verilen ağız bakımının oral mukozadaki bakteriyel kolonizasyon ve ağız sağlığı üzerine olan etkisininincelenmesidir.

Yöntem: Araştırma, deneysel kontrollü çalışma tasarımı ile yürütülmüştür. Bir Sağlık Uygulama ve Araştırma Merkezi’nin iki farklı yoğun bakımında 26.03.2017-20.02.2018 tarihleri arasında gerçekleştirilmiştir. Örneklemi, mekanik ventilatör desteği başlangıcından 24 saat geçmemiş olan 30 hasta oluşturmuştur. Hastalar deney ve kontrol olmak üzere iki gruba ayrılmıştır.  Deney grubundaki hastalara serum fizyolojik ve diş fırçası ile kontrol grubundaki hastalara NaHCO₃ ile ıslatılmış spanç ve abeslang yardımıyla ağız bakımı uygulanmıştır. Her iki gruba da dört gün süreyle günde dört kez ağız bakımı verilmiştir. Ağız sağlığı “ağız değerlendirme ölçeği” ile, bakteri kolonizasyonu ise 1. ve 4. gün pamuklu eküvyon çubukla ağızdan alınan örneklerin bakteriyolojik kültür sonuçlarına göre değerlendirilmiştir. Araştırmanın gerçekleştirilebilmesi için etik izin, kurumdan yazılı izin, hasta vasisinden aydınlatılmış onam alınmıştır. Verilerin değerlendirilmesinde Pearson Ki-Kare testi, t testi, Mann Whitney testi ve FisherExact test; McNemar testi kullanılmıştır.  

Bulgular: Hastalara verilen dört günlük ağız bakımı sonucunda her iki grupta da hastaların yarısına yakınında tükürüğünün yetersiz ve normalden daha yoğun olduğu; deney grubundaki hastaların diş plaklarında azalma olduğu görülmüştür. Ağız mukozasında bulunan bakteriler bakımından, 1. ve 4. gün alınan kültür sonuçlarının karşılaştırılmasına göre gruplar arasında istatistiksel olarak anlamlı farklılığın olmadığı belirlenmiştir. Ağız bakımında kullanılan serum fizyolojik ve diş fırçası ile NaHCO₃ ile ıslatılmış spanç ve abeslang yöntemlerinin etkin ancak birbirine üstünlüklerinin olmadığı saptanmıştır.

Sonuç: Mekanik ventilatör desteğindeki hastalar için bakım protokolleri çerçevesinde düzenli ağız bakımı yapılmasının bakteri kolonizasyonunu azalttığı, ağız sağlığını koruyucu ve geliştirici etkisi görülmüştür.

Anahtar Kelimeler

• Ağız bakımı,Mekanik ventilatör,Ağız mukozası,Diş fırçası,Yoğun bakım

The Effect Of Oral Care Given To Patients On Mechanical Ventilatory Support By Two Different Methods On Bacterial Colonization In Oral Mucosa And Oral Health

Öz

Aim: The aim of the study was to examine oral care given to the patients on mechanical ventilatory support by two different methods on bacterial colonization and oral health.

Methods: This study had a design including an experimental and a control group. Sample was composed of 30 patients who had mechanical ventilatory support less than 24 hours. Patients in the experimental group were applied toothbrush and serum physiological; and control group was applied oral care by abeslang and a sponge soaked with NaHCO₃. Both groups were given oral care four times a day for four days. Oral health was evaluated by “oral assessment scale”, and bacterial colonization was assessed based on bacteriological culture results of samples taken by cotton swab at days 1 and 4.

Results: It was found that almost half of the patients in both groups had insufficient saliva that was more viscous than normal; and dental plaques were decreased among the patients in the experimental group. In terms of bacteria in the oral mucosa, no statistically significant differences were found between the groups based on the comparison of culture results from days 1 and 4. It was found that both methods used for oral care were effective; and they had no superiority over each other.

Conclusions: It was concluded that application of regular oral care for the patients on mechanical ventilatory support as part of care protocols decreased bacterial colonization and had a protective and improving effect on oral health. 

Anahtar Kelimeler

• Oral care,Mechanical ventilator,Oral mucosa,Toothbrush,Intensive care

Kaynakça

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