預防呼吸器相關肺炎之口腔護理

Oral Care to Prevent Ventilator-Associated Pneumonia

呼吸器相關肺炎是加護病房中最常見的院內感染之一，不僅提升相關醫療成本，更直接增加病人住院天數、死亡率等不良預後。研究顯示，藉由口腔護理能有效降低呼吸器肺炎發生率，並促進病人舒適度，然而幾乎所有重症病人均無法自行執行口腔清潔，其相關評估及護理需全程仰賴護理師，是一項專門的護理技術。惟較少教科書或文獻系統性描述特殊族群之口腔評估、護理與口腔健康相關之潛在致病機轉。故本論述整理相關文獻，先介紹呼吸器相關肺炎之致病機轉，再詳述氣管內管留置病人口腔護理之目的、原理、步驟，尤其是目前以氯己定溶液執行口腔護理之實證結果，最後整理影響技術執行成效之原因。期待能以此文提升特殊族群口腔護理之意識、更新實證知識、以及促進護理照護品質。

Ventilator-associated pneumonia (VAP), one of the most common nosocomial infections in critical care units, has been associated with adverse outcomes such as higher medical expenses, prolonged hospital stays, and higher mortality rates. Although studies have demonstrated the effectiveness of oral care in reducing VAP incidence and enhancing patient comfort, few critically ill patients are able to perform oral care independently. Moreover, related evaluations and execution require specialized nursing techniques that rely on well-trained nurses. Unfortunately, descriptions of oral evaluations, caring practices, and hygiene related to pathogenic mechanisms in critically ill patients are scarce in both textbooks and the scientific literature. Based on a review of the related literature, this article discusses: the pathogenic mechanism of VAP; the purpose, principals, and steps of providing oral care to endotracheal tube ventilated patients, with particular emphasis on current evidence on the effect of chlorhexidine on oral care; and the major factors impacting oral care effectiveness. This article is expected to raise awareness of oral care, update the current evidence-based knowledge base, and increase the quality of nursing care provided to critically ill populations.