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广州医药杂志服务号
论著

综合性口腔护理干预方案在机械通气患儿中的应用

Application of comprehensive oral nursing intervention scheme in children with mechanical ventilation

:619-624
 
      目的 探究综合性口腔护理干预方案在机械通气患儿中的应用效果。方法 将2023年5月—12月泉州市妇幼保健院重症监护科接收的66例机械通气患儿选为研究对象。以密封信封抽签法分为综合干预组(n=33)及常规干预组(n=33)。常规干预组实施常规口腔护理,综合干预组实施综合性口腔护理模式干预。对比两组患儿口腔情况、并发症、静态全唾液流率(UWS)及机械通气时间。结果 干预后综合干预组Beck总分为(6.33±1.05)分,低于常规干预组的(8.55±1.85)分(t=6.069,P<0.001)。综合干预组出现呼吸机相关肺炎(VAP)发生率较常规干预组更低(3.03% vs 18.18%)(χ2=3.995,P=0.046)。干预后综合干预组UWS为(0.37±0.09)mg/min,高于常规干预组的(0.29±0.09)mg/min(t=3.611,P=0.001)。结论 综合性口腔护理模式能较大程度改进机械通气患儿的口腔卫生问题,对菌斑、口腔异味及牙龈情况均有改善作用;也能减少并发症发生率,提升UWS,维持口腔卫生健康。

      Objective To explore the effect of comprehensive oral nursing intervention in children with mechanical ventilation.Methods A total of 66 mechanically ventilated children admitted to the intensive care department of the hospital from May 2023 to December 2023 were selected as the study objects.They were divided into comprehensive intervention group(n=33)and routine intervention group(n=33)by sealed envelope lottery method.The routine intervention group implemented routine oral care,and the comprehensive intervention group implemented comprehensive oral care mode intervention.Oral conditions,complications,unstimulated whole saliva(UWS)and mechanical ventilation time were compared between the two groups.Results After the intervention,the total Beck score of the comprehensive intervention group was(6.33±1.05),which was lower than that of the conventional intervention group([8.55±1.85],t=6.069,P<0.001).The incidence of ventilator-associated pneumonia(VAP)in the comprehensive intervention group was lower than that in the conventional intervention group(3.03% vs 18.18%)(χ2=3.995,P=0.046).After the intervention,the UWS of the comprehensive intervention group was(0.37±0.09)mg/min,which was higher than that of the conventional intervention group([0.29±0.09] mg/min,t=3.611,P=0.001).Conclusions The comprehensive oral care mode can improve the oral health of children with mechanical ventilation to a great extent,and can improve the plaque,oral odor and gingiva condition.It can also reduce the incidence of complications,improve UWS,and maintain oral health.

医院管理

口腔门诊的医疗质量管理模式探讨

Discussion on the medical quality management model in dental outpatient care

:905-912
 
       医疗质量管理是医院的核心任务,医疗质量管理在医院内具体落实到各个专科的管理,口腔门诊(不含住院部)作为一个特殊的专科,广泛存在于一、二级医疗机构,也存在于部分三级医疗机构,普通住院科室或门诊专科的医疗质量管理模式均不适用于口腔门诊,需要专属的医疗质量管理方式。医疗质量管理常以质控检查与指标监测为抓手,本文综合目前关于口腔门诊质控的研究,系统梳理口腔门诊的质控检查项目与指标,为口腔门诊医疗质量管理模式提供科学依据。

      Medical quality management is the fundamental task of hospitals,and it is specifically implemented in the management of various specialties within hospitals.As a special specialty,dental outpatient clinics(excluding inpatient departments) exist in most primary and secondary medical institutions,as well as some tertiary medical institutions.The medical quality management methods of general inpatient departments or outpatient specialties are not applicable to dental outpatient clinics,which require a dedicated medical quality management approach.Quality control inspections and monitoring of quality control indicators are focuses of medical quality management.This article synthesizes current research on quality control in dental outpatient clinics,systematically sorts out quality control inspection items and quality control indicators for dental outpatient clinics,and provides a scientific basis for medical quality management model in dental outpatient clinics.

论著

数字化口内扫描印模技术对重度牙周炎患者口腔种植修复效果及龈沟液炎症因子水平的影响

The influence of digital intraoral impression technology on the restorative effect of oral implants and the levels of inflammatory factors in gingival crevicular fluid in patients with severe periodontitis

:762-766
 
       目的 研究数字化口内扫描印模技术(DIOS)对重度牙周炎(SP)患者口腔种植修复效果及龈沟液炎症因子水平的影响并进行分析。方法 选取医院2022年1月—2025年1月收治的100例SP患者进行研究。以密封信封抽签法分为数字化组(n=50)及常规组(n=50)。两组均开展口腔种植修复,常规组采用常规硅橡胶印模技术,数字化组则采用DIOS。对比两组印模制取时间、印模过程中疼痛程度及种植成功率、修复体满意度、龈沟液炎症因子水平、并发症发生情况。结果 数字化组印模制取时间短于常规组,VAS评分低于常规组,而种植成功率高于常规组(均P<0.05)。数字化组边缘密合度、咬合关系、邻接关系满意度均高于常规组(均P<0.05)。修复3个月后两组龈沟液各项炎症因子水平均低于修复前,且数字化组低于常规组(均P<0.05)。数字化组并发症总发生率低于常规组(P<0.05)。结论 DIOS可显著提高SP患者口腔种植修复效果,降低龈沟液炎症因子水平,减少并发症的发生。

      Objective To investigate the effects of digital intraoral scanner(DIOS)on the oral implant restoration effect and the levels of inflammatory factors in gingival crevicular fluid in patients with severe periodontitis(SP).Methods A total of 100 SP patients admitted to the hospital from January 2022 to January 2025 were selected for the study.They were divided into the digital group(n=50)and the conventional group(n=50)by the sealed envelope lottery method.Both groups underwent oral implant restoration.The conventional group used the conventional silicone rubber impression technology,while the digital group underwent DIOS.The time of impression preparation,the degree of pain during the impression process,the success rate of implantation,the satisfaction of restorations,the levels of inflammatory factors in gingival crevicular fluid,and the occurrence of complications were compared between the two groups.Results The impression acquisition time of the digital group was shorter than that of the conventional group,the VAS score was lower than that of the conventional group,while the implantation success rate was higher than that of the conventional group(all P<0.05).The marginal fit,occlusal relationship and adjacent relationship in the digital group were all higher than those of the conventional group(all P<0.05).Three months after repair,the levels of various inflammatory factors in gingival crevicular fluid in both groups were lower than those at admission,and the digital group was lower than the conventional group(all P<0.05).The total incidence of complications in the digital group was lower than that in the conventional group(P<0.05).Conclusions DIOS can significantly improve the oral implant restoration effect of SP patients,reduce the levels of inflammatory factors in gingival crevicular fluid,and reduce the occurrence of complications.

论著

孕中晚期口腔二维轴向切面超声诊断唇腭裂类型的价值研究

The value of two-dimensional axial sectional ultrasonography in the diagnosis of cleft lip and palate in the second and third trimesters of pregnancy

:83-87
 
       目的   探讨孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中的应用价值,评估其对唇裂、唇腭裂及继发腭裂的检出率和准确性。方法   本研究为前瞻性研究,共纳入2020年3月—2023年12月在我院超声科行产前超声诊断的3 666例孕中晚期胎儿,其中经超声检查诊断出111例唇腭裂,这些病例归为唇腭裂组,其余3 555例归入正常对照组。所有受试者均通过口腔二维轴向切面超声进行评估,诊断结果经产后随访确认。结果   在正常对照组中,上唇及上牙槽突的评估成功率为100%,软硬腭分界线显示率为99%,软腭显示率为85%。在唇腭裂组中,超声对唇裂、唇腭裂及继发腭裂的检出率分别为45%、48%和7%,且超声诊断的灵敏度、特异度和预测值均超过98%。结论   孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中具有较高的准确性和可靠性,为早期干预和临床管理提供了重要的影像学依据。
       Objective  To explore the application value of two-dimensional axial section ultrasound in prenatal diagnosis of fetal cleft lip and palate in the second and third trimesters of pregnancy,and to evaluate its detection rate and accuracy for cleft lip,cleft lip and palate,and secondary cleft palate.Methods  This study is a prospective study that included 3 666 fetuses in the second and third trimesters of pregnancy.Among them,111 cases of cleft lip and palate were diagnosed by ultrasound examination.These cases were classified as the cleft lip and palate group,and the remaining 3 555 cases were classified as the normal control group.All subjects were evaluated by oral two-dimensional axial section ultrasound,and the diagnostic  results were confirmed by postpartum follow-up.Results  In the normal control group,the success rates of evaluating the upper lip and upper alveolar process were 100%.The present rate of the soft hard palate boundary was 99%,and the present rate of the soft palate was 85%.In the cleft lip and palate group,the detection rates of cleft lip,cleft lip and palate,and secondary cleft palate by ultrasound were 45%,48% and 7% respectively,and the sensitivity,specificity,and predictive value of ultrasound diagnosis exceeded 98%.Conclusions  Two dimensional axial section ultrasound of the oral cavity in second and third trimesters of pregnancy has high accuracy and reliability in prenatal diagnosis of fetal cleft lip and palate,providing strong imaging evidence for early intervention and clinical management.
论著

慢性阻塞性肺疾病患者口腔功能状况的影响因素分析

Analysis of risk factors for oral function in patients of chronic obstructive pulmonary disease

:41-47
 
目的 探讨慢性阻塞性肺疾病(COPD)住院患者口腔功能状态现状及影响因素。方法 采用便利抽样法,选择2022年9月—2023年7月在深圳市龙岗区某三甲医院呼吸内科、胸外科的老年COPD住院患者191例作为研究对象。使用一般资料调查表、日常生活自理能力评估量表(BADL)、反复唾液吞咽试验(RSST)、改良版呼吸困难量表(mMRC)、改良版Beck口腔评分量表进行调查及评估。采用单因素分析老年COPD住院患者口腔功能状态的影响因素,采用Logistic回归分析老年COPD住院患者口腔功能状态的影响因素。结果 191例老年COPD患者中,入院时、住院第3天(D3)、住院第5天(D5)、出院的Beck口腔评分分别为(10.79±2.51),(10.91±2.82),(11.21±2.30),(10.83±2.55)分,比较差异无统计学意义(P>0.05)。单因素分析结果显示,COPD患者在D3、D5、出院时,Beck口腔功能状态的影响因素有:年龄、性别、婚姻状况、牙齿缺失情况、抽烟史以及生活自理能力影响,差异具有统计学意义(P<0.05)。二元Logistic回归分析结果显示,年龄、吸烟状况、牙齿缺失数量、生活自理能力是COPD住院患者口腔功能状态的影响因素(P<0.05)。结论 老年COPD患者口腔卫生状况较差,且受到年龄、吸烟情况、牙齿缺失、生活自理能力的影响,应采取针对性预防和干预策略,改善老年COPD住院患者的口腔卫生状况,以降低COPD患者发生并发症的风险。
Objective To investigate the status quo and influencing factors of oral function in hospitalized patients of chronic obstructive pulmonary disease(COPD).Methods A total of 191 patients with COPD who were hospitalized in the Respiratory Department and Thoracic Surgery Department of a hospital in Longgang,Shenzhen from September 2022 to July 2023 were selected by convenience sampling.The general data questionnaire,the Barthel index of activity of daily living(BADL) the repetitive saliva swallowing test(RSST),modified Medical Research Council Dyspnea Scale(mMRC),the Modified Beck Oral Assessment Scale(BOAS)were used for investigation and evaluation.Single factor analysis was used to analyze the influencing factors of oral function status in elderly COPD patients,and logistic regression was used to analyze the independent risk factors affecting oral function status in elderly COPD patients.Results Among 191 elderly patients with COPD,the BOAS scores were(10.79±2.51),(10.91±2.82),(11.21±2.30),(10.83±2.55)at admission,the 3rd day,the 5th day and discharged day,respectively,with no statistical significance.The results of univariate analysis indicated that the independent risk factors of Beck oral function status in COPD patients at D3,D5 and discharge were gender,age,marital status,tooth loss,smoking history and Barthel index score,and the differences were statistically significant(P <0.05).Binary logistic regression analysis indicated that age,smoking status,tooth loss and Barthel index score were independent risk factors for oral function status in hospitalized patients with COPD(P<0.05).Conclusions Elderly patients with COPD have poor oral health status,which is affected by patient's age,smoking history,tooth loss and self-care ability.Targeted prevention and intervention strategies should be adopted to improve the oral health status of hospitalized patients with COPD,so as to reduce the COPD patient's risk of complications.
论著

中老年人口腔健康相关生活质量评价及其影响因素分析

Evaluation of oral health related quality of life and its influencing factors in middle-aged and elderly people

:50-58
 
目的 通过关注追踪中老年人口腔健康问题对生活质量的影响,系统梳理中老年人口腔健康的相关影响因素及其关系,为此类人群的口腔健康及其相关生活质量的活动开展提供调研依据。方法 随机抽取2022年10月—2023年5月之间的266名中老年人参与调查,按照“病因链”收集该类人群的社会学特征、日常口腔保健行为、身体健康状况,分析评价中老年人口腔健康相关生活质量。结果 266名中老年人口腔健康常识和行为得分平均为(30.69±8.98)分,口腔健康评估平均为(8.59±3.68)分,口腔健康相关生活质量GOHAI总分为(25.65±8.10)分。单因素分析显示,人口学特征与一般身体健康状况、口腔健康常识和行为以及口腔健康情况与中老年人的口腔健康相关生活质量的GOHAI得分密切相关(P<0.05)。多因素分析显示,女性、年龄>45岁、患慢性病、日常生活习惯是影响中老年口腔健康和生活质量的独立危险因素(P<0.05或P<0.01)。结论 口腔健康作为全身健康的基础,其影响因素多种多样,通过控制干预主要影响因素来提高社区口腔健康和相关生活质量,以改善社区居民生活幸福值。
Objective By focusing on and tracking the impact of oral health problems of middle-aged and elderly people on the quality of life,the relevant influencing factors and relationships of oral health were systematically sorted out to provide a research basis for the development of oral health and related quality of life of such people.Methods A total of 266 middle-aged and elderly people were randomly selected from October 2022 to May 2023 to participate in the survey,and the sociological characteristics,daily oral health care behaviors and physical health status of this population were collected according to the “etiological chain”,so as to analyze and evaluate the quality of life related to the oral health of middle-aged and elderly people.Results The 266 middle-aged and elderly people had a mean score of(30.69±8.98)for general knowledge and behavioral scores of oral health,a mean score of(8.59±3.68)for oral health assessment,a total score of(25.65±8.10)for oral health-related quality of life GOHAI.The univariate analysis showed that demographic characteristics,general body health state,oral health cognition and behavior and oral health state were closely associated with the GOHAI score related to the oral health associated quality of life in the middle-aged and elderly people(P<0.05).The multivariate analysis indicated that female,age >45 years old,presence of chronic diseases and daily living habits were indepdent risk factors of the oral health and quality of life of the middle-aged and elderly(P<0.05).Conclusions Oral health,as the basis of systemic health,has various influencing factors,by controlling the main influencing factors can improve the community oral health and related quality of life,and improve the happiness of community residents.
临床诊疗

牙周基础治疗联合口腔正畸对牙周炎患者炎症细胞因子的疗效分析

:122-126
 
目的 观察牙周基础治疗联合口腔正畸对牙周炎患者炎症细胞因子的疗效分析。方法 以2017年4月—2018年5月于我院医院进行治疗的82例牙周炎患者为研究对象,按随机数字表法分为研究组(41例,给予牙周基础治疗联合口腔正畸)和对照组(41例,口腔正畸)。观察两组患者治疗后临床疗效,对比治疗前后两组患者牙周指数情况、血清炎症因子及咀嚼功能。结果 治疗1周后,研究组有效率高于对照组(97.56% vs 82.93%),组间比较(P<0.05)。治疗前,两组SBI、PLI、GI比较(P>0.05);治疗1周后,两组SBI、PLI、GI均低于治疗前,与对照组SBI、PLI、GI比较,研究组降低,组间比较(P<0.05)。治疗前,两组AL、PD比较(P>0.05);治疗1周后,两组AL、PD均低于治疗前,与对照组AL、PD比较,研究组降低,组间比较(P<0.05)。治疗前,两组TNF-α、IL-8及IL-6水平比较(P>0.05);治疗1周后,两组TNF-α、IL-8及IL-6水平均低于治疗前,与对照组TNF-α、IL-8及IL-6水平比较,研究组下降明显,组间比较(P<0.05)。治疗前,研究组及对照组的咀嚼功能分别为(51±2)分、(52±2)分,两组比较(P>0.05);治疗后1周,研究组及对照组的咀嚼功能分别为(85±4)分、(73±3)分,研究组咀嚼功能明显高于对照组,组间比较(P<0.05)。结论 牙周基础治疗联合口腔正畸治疗牙周炎患者效果确切,可降低炎症反应,值得临床推广应用。
论著

口腔综合修复技术在牙隐裂患者中的应用分析

Application of comprehensive prosthodontics in patients with cracked teeth

:73-75
 
目的 探讨口腔综合修复技术应用于牙隐裂中的临床疗效,为牙隐裂的治疗路径提供参考依据。方法 我院所接收的牙隐裂患者为试验样本,共52例,选入期间为2019年1月—2020年12月,将其予以随机分组,其中对照组(n=26例)和观察组(n=26例),对照组施以常规治疗,观察组施以口腔综合修复技术治疗,评测各组的临床疗效、SF-36评分、咀嚼功能评分以及临床症状消退时间。结果 观察组总有效率为96.15%,低于对照组76.92%(P<0.05);观察组干预后的疼痛程度评分低于对照组(P<0.05);观察组牙面裂纹消退时间、冷热刺激消退时间、 咀嚼疼痛消退时间均低于对照组(P<0.05)。结论 通过口腔综合修复技术治疗牙隐裂患者,可取得确切疗效,有助于缓解临床症状。
Objective To investigate the clinical effect of comprehensive prosthodontics in the treatment of cracked teeth, and to provide reference for the treatment of cracked teeth. Methods Fifth-two patients with cracked teeth in our hospital from January 2019 to December 2020 were randomly divided into control group (n=26) and observation group (n=26). The control group was treated with conventional treatment, and the observation group was treated with oral comprehensive repair technology. The clinical efficacy, SF-36 score, masticatory function score and the time for symptoms to subside of each group were evaluated. Results The total effective rate of the observation group was 96.15%, which was lower than 76.92% of control group(P<0.05); the pain score of the observation group after the intervention was lower than that of the control group (P<0.05); the tooth surface crack regression time, hot and cold stimulation regression time, masticatory pain regression time of the observation group were shorter than those of the control group (P<0.05). Conclusion Comprehensive prosthodontics treatment for cracked teeth can obtain exact curative effect and help to relieve clinical symptoms.
论著

口腔种植修复和常规修复在牙列缺损治疗中的有效性分析

Efficacy analysis of dentition defects treated with dental implant and conventional repair

:72-75
 
目的 分析口腔种植修复和常规修复在牙列缺损治疗中的有效性。方法 选定本院2019年1月—2020年12月接诊的120例牙列缺损患者,根据修复治疗方法的不同分组,参照组60例患者采取常规修复治疗,实验组60例患者采取口腔种植修复,比较两组临床疗效、龈沟炎症因子水平、并发症发生率、满意度评分。结果 实验组临床总有效率(96.67%)高于参照组(78.33%),实验组治疗后龈沟TNF-α、IL-8、IL-6因子均低于参照组,实验组并发症发生率(1.67%)低于参照组(13.33%),实验组患者满意度评分均高于参照组,差异均有统计学意义(P<0.05)。结论 口腔种植修复可有效改善牙列缺损患者语言、咀嚼功能,减轻龈沟炎症反应,减少并发症,提高患者满意度。
Objective To analyze the efficacy of dental implant and conventional repair in the treatment of dentition defects. Methods A total of 120 patients with dentition defects in our hospital from January 2019 to December 2020 were selected and divided into two groups according to different treatment methods. Sixty patients in the control group were treated with conventional repair, and 60 patients in the experimental group were treated with dental implant repair. The clinical efficacy, gingival crevicular inflammatory factors level, complication incidence and satisfaction score of the two groups were compared. Results The clinical efficacy of the experimental group (96.67%) was higher than that of the control group (78.33%), the levels of TNF-α, IL-8 and IL-6 in the gingival sulcus of the experimental group were lower than those of the control group after treatment, the complications incidence of the experimental group (1.67%) was lower than that of the control group (13.33%), and the satisfaction score of the experimental group was higher than that of the control group, the differences were statistically significant (P<0.05). Conclusion Dental implant repair could effectively improve the language and chewing function of patients with dentition defects, reduce gingival crevicular inflammatory reaction, complications and improve patients' satisfaction.
论著

口腔门诊不同层级护士急救能力的调查研究

Investigation on the first aid ability of nurses at different levels in the dental clinic

:103-106
 
目的 调查口腔专科医院门诊不同层级护士急救能力的现状,进一步探讨优化口腔门诊护士急救培训模式。方法 选取2019年1月—2020年1月我院口腔门诊护士97名,采用自设问卷调查及现场操作技能评估对护士进行考核,调查护士的急救能力。结果 口腔科门诊不同层级护士的急救能力(包括相关知识与操作能力)差异有统计学意义(P<0.05)。其中,N1级(工作1~<3年)的护理人员急救能力低于N2级(工作3~5年)的护理人员。N3级(工作6~10年)的急救知识考核分、操作考核分略低于工作N2级护士,但差异无统计学意义。而不同年龄、学历、职称、科室的护士急救能力的差异无统计学意义。结论 口腔门诊护士急救培训应分层级进行,特别应加强N1级以下护理人员的急救技能培训,保证护士急救培训效果同质化,对口腔门诊诊疗中提高医疗安全及护理质量具有重要意义。
Objective To investigate the current status of the first-aid ability of nurses at different levels in outpatient clinics of stomatological hospitals, and to further explore the optimization of the training model of first-aid nurses in outpatient clinics. Methods A total of 97 nurses in our outpatient clinic from January 2019 to January 2020 were selected. The nurses were assessed by self-designed questionnaire surveys and on-site operation skills assessment to investigate the nurses' first aid ability. Results The difference in first aid ability (including relevant knowledge and operation ability) of nurses at different levels in the dental clinic was statistically significant (P<0.05). Among them, the first-aid ability of nursing staff of N1 grade (working 1 ~<3 years) is lower than that of nursing staff of N2 grade (working 3 ~ 5 years). The N3 level (working 6~10 years) first aid knowledge assessment and operation assessment scores are slightly lower than those of working N2 nurses, but the difference is not statistically significant. There was no statistically significant difference in the first aid ability in nurses of different ages, educational backgrounds, titles, and departments. Conclusion The first-aid training of nurses in oral clinics should be conducted in different levels, especially the first-aid skills training of nurses below N1 level. We should be strengthened to ensure the homogenization of nurse's first-aid training effect, which is of great significance to improve medical safety and quality of care in oral clinics.
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