ICU经口气管插管患者口腔黏膜压力性损伤的研究进展

doi:10.3761/j.issn.2096-7446.2023.05.019

摘要/Abstract

摘要： ICU内黏膜压力性损伤常发生在口腔部位,增加患者疼痛,严重影响患者生活质量。该文从口腔黏膜压力性损伤的流行病学、评估及分期、影响因素及干预措施等方面进行综述,以期为临床医护人员进行口腔黏膜压力性损伤临床实践管理及开展相关研究提供参考。

关键词: 重症监护病房, 插管法, 气管内, 黏膜压力性损伤, 综述文献（主题）

Abstract: Oral mucosal pressure injury is the most common mucosal pressure injury in ICU,which can increase the pain of patients and seriously affect the quality of life of patients. This article reviews the epidemiology,assessment and staging,influencing factors and intervention measures of oral mucosal pressure injury,in order to provide reference for clinical medical staff to manage oral mucosal pressure injury in clinical practice and conduct further related research.

Key words: Intensive Care Units, Intubation, Intratracheal, Mucosal Pressure Injury, Review Literature as Topic

李茜, 王丽竹, 朱祎容, 樊帆. ICU经口气管插管患者口腔黏膜压力性损伤的研究进展[J]. 中华急危重症护理杂志, 2023, 4(5): 473-477.

LI Qian, WANG Lizhu, ZHU Yirong, FAN Fan. Research progress of oral mucosal pressure injury in ICU patients with oral tracheal intubation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(5): 473-477.

参考文献

[1] NPIAP,EPUAP,PPPIA. Prevention and Treatment of pressure ul-cers/injuries:quick reference guide[EB/OL].(2019-03-10)[2022-09-22]. https://www.internationalguideline.com/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf.
[2] 南锐伶,裴菊红,张亚斌,等. 黏膜压力性损伤的护理研究进展[J]. 解放军护理杂志,2020,37(12):62-64.
Nan RL,Pei JH,Zhang YB,et al.Nursing research progress on mucosal membrane pressure injury[J]. Nurs J Chin PLA,2020, 37(12):62-64.
[3] Erbay Dallı Ö,Ceylan İ,Kelebek Girgin N.Incidence,characteristics and risk factors of medical device-related pressure injuries:an observational cohort study[J]. Intensive Crit Care Nurs, 2022,69:103180.
[4] Karadag A,Hanönü SC,Eyikara E.A prospective,descriptive study to assess nursing staff perceptions of and interventions to pre-vent medical device-related pressure injury[J]. Ostomy Wound Manage,2017,63(10):34-41.
[5] Hampson J,Green C,Stewart J,et al.Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the intensive care unit:a retrospective observational study[J]. BMC Nurs,2018, 17:4.
[6] Kim CH,Kim MS,Kang MJ,et al.Oral mucosa pressure ulcers in intensive care unit patients:a preliminary observational study of incidence and risk factors[J]. J Tissue Viability,2019, 28(1):27-34.
[7] Coyer FM,Stotts NA,Blackman VS.A prospective window into medical device-related pressure ulcers in intensive care[J]. Int Wound J,2014,11(6):656-664.
[8] Amrani G,Gefen A.Which endotracheal tube location minimises the device-related pressure ulcer risk:the centre or a corner of the mouth?[J]. Int Wound J,2020,17(2):268-276.
[9] Kang MK,Kim MS.Effects of attitude,barriers/facilitators,and visual differentiation on oral mucosa pressure ulcer prevention performance intention[J]. Healthcare (Basel),2021,9(1):76.
[10] Barakat-Johnson M,Lai M,Wand T,et al.The incidence and prevalence of medical device-related pressure ulcers in intensive care:a systematic review[J]. J Wound Care,2019,28(8):512-521.
[11] Fulbrook P,Lovegrove J,Butterworth J.Incidence and characteristics of hospital-acquired mucous membrane pressure injury:a five-year analysis[J]. J Clin Nurs,2022,e16473.
[12] 刘迪. EICU经口气管插管患者发生相关性口腔黏膜压力性损伤的现状及影响因素分析[D]. 北京:北京协和医学院,2022.
Liu D.Analysis of the current situation and influencing factors of oral mucosal pressure injury in patients with EICU orotracheal intubation[D]. Beijing:Peking Union Medical College,2022.
[13] Choi BK,Kim MS,Kim SH.Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units:a prospective observational study[J]. J Tissue Viability,2020,29(4):252-257.
[14] 黄灿,马玉霞,蒋梦瑶,等. 压力性损伤风险评估工具的研究进展[J]. 上海护理,2021,21(1):50-53.
Huang C,Ma YX,Jiang MY,et al.Research progress of stress injury risk assessment tools[J]. Shanghai Nurs,2021,21(1):50-53.
[15] 黄庆萍,张建荣,郑美春,等. ICU医疗器械相关性压力性损伤风险评估量表在危重患者中的应用研究[J]. 中华护理杂志,2018,53(8):967-970.
Huang QP,Zhang JR,Zheng MC,et al.Application of risk assessment scale for ICU medical device-related pressure injuries in critically ill patients[J]. Chin J Nurs,2018,53(8):967-970.
[16] Reaper S,Green C,Gupta S,et al.Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale(ROMPIS):a novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa[J]. Aust Crit Care,2017,30(3):167-171.
[17] Fitzgerald S,McTier L,Whitehead C,et al. Inter-rater reliability of descriptors for the classification of mucosal pressure injury:a prospective cross-sectional study[J]. Aust Crit Care,2022:S1036-S7314(21)00178-8.
[18] Coleman S,Nixon J,Keen J,et al.A new pressure ulcer conceptual framework[J]. J Adv Nurs,2014,70(10):2222-2234.
[19] Nedergaard HK,Haberlandt T,Toft P,et al.Pressure ulcers in critically ill patients-preventable by non-sedation? A substudy of the NONSEDA-trial[J]. Intensive Crit Care Nurs,2018,44:31-35.
[20] Munoz N,Posthauer ME,Cereda E,et al.The role of nutrition for pressure injury prevention and healing:the 2019 international clinical practice guideline recommendations[J]. Adv Skin Wound Care,2020,33(3):123-136.
[21] Shapira-Galitz Y,Karp G,Cohen O,et al.Evaluation and predictors for nasogastric tube associated pressure ulcers in critically ill patients[J]. Isr Med Assoc J,2018,20(12):731-736.
[22] Buranarom N,Komin O,Matangkasombut O.Hyposalivation,oral health,and Candida colonization in independent dentate Elders[J]. PLoS One,2020,15(11):e0242832.
[23] Kim SH,Nah HS,Kim JB,et al.Relationships between oral-mucosal pressure ulcers,mechanical conditions,and individual susceptibility in intubated patients under intensive care:a PCR-based observational study[J]. Biol Res Nurs,2021,23(4):557-567.
[24] Sarkar A,Xu F,Lee S.Human saliva and model saliva at bulk to adsorbed phases-similarities and differences[J]. Adv Colloid Interface Sci,2019,273:102034.
[25] Jang CS,Shin YS.Effects of combination oral care on oral health,dry mouth and salivary pH of intubated patients:a randomized controlled trial[J]. Int J Nurs Pract,2016,22(5):503-511.
[26] 缪国璧,唐梦琳. 经口气管插管固定牙垫对皮肤损伤的研究[J]. 护士进修杂志,2016,31(24):2291-2292.
Miao GB,Tang ML.Study on skin injury caused by oral intubation and fixation of dental pad[J]. J Nurses Train,2016, 31(24):2291-2292.
[27] Landsperger JS,Byram JM,Lloyd BD,et al.The effect of adhesive tape versus endotracheal tube fastener in critically ill adults:the endotracheal tube securement(ETTS）randomized controlled trial[J]. Crit Care,2019,23(1):161.
[28] 章勤,宋长春,邹琪,等. 改良经口气管插管固定法对ICU患者口面颈部器械性压力损伤的效果观察[J]. 中华全科医学,2020,18(8):1421-1424.
Zhang Q,Song CC,Zou Q,et al.Observation on the clinical effect of modified oral endotracheal intubation method on ICU patients with instrumental pressure injury[J]. Chin J Gen Pract,2020,18(8):1421-1424.
[29] 罗燕. 新型硅胶牙垫在成人气管插管患者中的应用研究[D]. 南昌:南昌大学,2021.
Luo Y.Application of new silicone dental pad in adult pa-tients with endotracheal intubation[D]. Nanchang:Nanchang University,2021.
[30] Aydin C,Donaldson N,Stotts NA,et al.Modeling hospital-acquired pressure ulcer prevalence on medical-surgical units:nurse workload,expertise,and clinical processes of care[J]. Health Serv Res,2015,50(2):351-373.
[31] Cremasco MF,Wenzel F,Zanei SS,et al.Pressure ulcers in the intensive care unit:the relationship between nursing workload,illness severity and pressure ulcer risk[J]. J Clin Nurs,2013,22(15/16):2183-2191.
[32] Tschannen D,Anderson C.The pressure injury predictive mo-del:a framework for hospital-acquired pressure injuries[J]. J Clin Nurs,2020,29(7/8):1398-1421.
[33] 李紫芬,欧玉兰,王潘,等. ICU病人医疗器械压力性损伤相关临床实践指南的质量评价与内容分析[J]. 循证护理,2022,8(3):285-290.
Li ZF,Ou YL,Wang P,et al.Quality evaluation and content analysis of clinical practice guidelines related to pressure injury of medical devices in ICU patients[J]. Chin Evid Based Nurs,2022,8(3):285-290.
[34] Wickberg M,Falk AC.The occurrence of pressure damage in the oral cavity caused by endotracheal tubes[J]. Nord J Nurs Res,2017,37(1):2-6.
[35] 中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南[J]. 中华危重病急救医学,2018,30(6):497-514.
Intensive Medicine Branch of Chinese Medical Association. Guidelines for analgesia and sedation treatment in intensive care unit of Chinese adults[J]. Chin Crit Care Med,2018,30(6):497-514.