脳低温療法時の肺酸素化能に及ぼす口鼻腔内ケアの効果

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  • Effects of Oro-nasal Care on Pulmonary Oxygenation During Moderate Hypothermia Therapy for Brain-Injured Patients.

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We have retrospectively studied the effects of oro-nasal care on pulmonary oxygenation during moderate hypothermia therapy in 16 patients with cerebral vascular disease or head trauma. Moderate hypothermia were undergone for 3-16 days. Seven of 16 patients did not receive regular mouth care (group A), and the others were treated with regular mouth care more than three times a day (group B). PaO2/FIO2 ratio (P/F ratio), CRP, WBC counts and chest x-rays were examined. Oro-nasal or tracheal secretions were cultured for bacteriological examination. In this study, the frequency of P/F ratio less than 250 in all samples during the therapy, including rewarming period, was defined as the index for determining pulmonary oxygenation (the decreased frequency). Statictical analysis was done by student t-test or Mann-Whitney U-test as appropriate. P values less than 0.05 were considered significant. The decreased frequency in group B was significantly lower than that of group A, suggesting group B had superior pulmonary oxygenation to group A. CRP on admission was not different between the groups, but the variable in group B was significantly lower than that of group A in the hypothermic and rewarming period. Changes in WBC counts between the groups were not significantly different. On chest X-ray, the mean rate of development of consolidation was significantly higher at 18.1±10.4% in group A than group B (0%). These data show that oronasal care more than three times a day improves pulmonary oxygenation during hypothermia therapy for braininjured patients.

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