The randomized trial for Effect of oral health care on the recovery from surgery in elderly patients

本研究的目的是阐明消化道手术后口腔护理的有效性，包括刷牙、义齿清洁和舌头清洁。研究对象为30例自愿接受消化道手术的老年患者，年龄在60 ~ 98岁之间（平均76.9±7.8岁）。采用系统抽样方法，将研究对象分为干预组和对照组。干预组每天早上7点到8点进行5分钟的口腔护理：用聚维酮碘漱口，刷牙，用专用牙刷清洁假牙，用舌刷清洁舌头。在对照组，受试者只用聚维酮碘漱口。比较干预组和对照组的剩余牙齿数量、假牙使用情况、口干感觉、牙石沉积、牙齿活动度和挥发性硫化合物。然后比较干预组和对照组从手术时间到术后第5天的肺活量、硫化物、肺音、咽部细菌和发热的变化。干预组肺异常音发生率由6.6上升至13.0%（上升6.4%），对照组由0上升至26.6% （p<0.05， Fisher直接概率检验）。对照组患者平均细菌数量术前为3.64±1.34种，术后为3.50±1.74种；干预组患者平均细菌数量术前为3.08±0.95种，术后为2.62±0.65种。干预组细菌种类数量显著减少（p<0.05，t检验）。干预组和对照组术前至术后5 d硫化氢水平的平均变化程度（ng/10ml）分别为-2.93±8.08和0.81±4.86；甲基硫醇分别为-1.10±2.30和0.40±1.72；对于二甲基硫，分别为-0.36±1.30和0.16±1.60。与对照组相比，干预组各挥发性硫化合物水平均显著降低，其中甲基硫醇水平差异有统计学意义（p<0.001，t检验）。由于厌氧细菌参与了口腔中挥发性硫化合物的产生，因此挥发性硫化合物的浓度被认为反映了口腔中细菌的数量。本研究结果阐明，老年消化道手术患者术后口腔护理可降低口腔细菌种类，减轻呼吸功能障碍。少

The purpose of the present study was to clarify the effectiveness of postoperative oral care, including toothbrushing, denture cleaning and tongue cleaning following digestive tract surgery.The subjects were 30 consenting elderly patients aged between 60 and 98 years (mean, 76.9±7.8 years) who underwent digestive tract surgery. Using a systematic sampling method, subjects were divided into two groups : an intervention group, and a control group. In the intervention group, the following oral care was provided daily over a five-minute period between 7 and 8 in the morning : gargling with povidone iodine, tooth brushing, denture cleaning using a special brush, and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. The number of remaining teeth, denture usage, sensation of dry mouth, dental calculus deposition, tooth mobility, and volatile sulfur compounds were compared between the intervention and control groups. Then, changes in vo … More latile sulfur compounds, pulmonary sounds, pharyngeal bacteria and fever from the time of operation to five days after surgery were compared between the intervention and control groups.The incidence of abnormal pulmonary sounds for the intervention group increased from 6.6 to 13.0% (an increase of 6.4%), while that for the control group increased from 0 to 26.6% (p<0.05, Fisher's direct probability test). The average number of bacterial species per subjects for the control group was 3.64±1.34 preoperatively and 3.50±1.74 postoperatively, whereas that for the intervention group was 3.08±0.95 preoperatively and 2.62±0.65 postoperatively. In the intervention group, there was a significant decrease in the number of bacterial species (p<0.05,t-test). The average degree of change (ng/10ml) in hydrogen sulfide levels from before surgery to five days after surgery for the intervention and control groups was -2.93±8.08 and 0.81±4.86,respectively ; for methyl mercaptan, -1.10±2.30 and 0.40±1.72,respectively ; for dimethyl sulfide -0.36±1.30 and 0.16±1.60,respectively. When compared to the control group, the level of each volatile sulfur compound markedly decreased for the intervention group, and there was a statistically significant difference in methyl mercaptan (p<0.001,t-test).Since anaerobic bacteria are involved in the production of volatile sulphur compounds in the oral cavity, the volatile sulphur compounds concentration is believed to reflect the number of bacteria in the mouth. The findings in the study clarify that postoperative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity and alleviates respiratory dysfunction. Less