Гигиенический статус полости рта критических пациентов в отделении реанимации и интенсивной терапии при применении различных протоколов гигиены полости рта
Научно-практический журнал Институт Стоматологии №2 (111), июнь 2026
стр. 15-17
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250 руб.
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Аннотация
Недостаточная гигиена полости рта критических пациентов отделения реанимации и интенсивной терапии может привести к распространению патогенов и увеличению риска патологии в других органах. Целью исследования было оценить эффективность различных протоколов гигиены полости рта критических пациентов отделения реанимации и интенсивной терапии. Проведено рандомизированное контролируемое исследование с участием 24 критических пациентов, находящихся на искусственной вентиляции легких (ИВЛ). Пациенты были рандомизированы на две группы: группа 1 (контрольная) и группа 2 (основная). На 1-й, 2-й и 5-й дни определяли гигиенический статус до и после гигиены полости рта по индексу Силнес—Лоу и с помощью аппарата Qscan Plus. Статистическую обработку данных осуществляли c помощью пакетов прикладных программ Statistica 10 и SAS JMP 11. По результатам исследования гигиенический статус полости рта критических пациентов в 1-й день до гигиены полости рта в обеих группах был неудовлетворительным: в группе 1 равен 1,7±0,45; в группе 2 — 1,92±0,51. На 2-й день до обработки полости рта выявлены статистически значимые показатели в снижении индекса гигиены полости рта в группе 2 — в среднем на 1,7 по отношению к группе 1 (p<0,0001), в которой показатель индекса гигиены был значительно выше — 1,67±0,49. На 5-й день до проведения гигиены полости рта статистически значимое различие обнаружено для показателя индекса гигиены в группе 1 (1,50±0,52) — в среднем на 1,4 выше по отношению к группе 2 (0,00±0,00) (p<0,0001). Снижение индексов гигиены, то есть улучшение гигиенического статуса, отмечено в двух исследуемых группах. Показатели индекса гигиены группы 2 (основная) статистически значимо отличаются при первом применении процедуры и показывают высокую эффективность применяемого протокола на 2-й и 5-й дни наблюдения (p <0,0001).
Аннотация (англ)
Poor oral hygiene in critically ill patients in intensive care units (ICUs) contributes to the accumulation and colonization of plaque by pathogenic bacteria, which leads to the spread of pathogens and increases the risk of pathology in other organs. The aim of the study was to evaluate the effectiveness of different oral hygiene protocols in critically ill patients in the intensive care unit. A randomized controlled trial was conducted involving 24 critically ill patients on mechanical ventilation (MV). Patients were randomized into two groups: Group 1 (control) and Group 2 (study). On days 1, 2, and 5, oral hygiene status was determined before and after oral hygiene using the Silnes-Law Index and the Qscan Plus device. Statistical data processing was performed using Statistica 10 and SAS JMP 11 software packages. The oral hygiene status of critically ill patients on the 1st day before oral hygiene was unsatisfactory in both groups: in group 1 it was 1.7±0.45; in group 2 — 1.92±0.51. On the 2nd day before oral hygiene, statistically significant indicators were found in the decrease in the oral hygiene index in group 2 by an average of 1.7 in relation to group 1 (p<0.0001), in which the hygiene index was significantly higher — 1.67±0.49. On the 5th day before oral hygiene, a statistically significant difference was found for the hygiene index in group 1 (1.50±0.52) by an average of 1.4 higher in relation to group 2 (0.00±0.00) (p<0.0001). A reduction in hygiene indices, i.e., an improvement in hygiene status, was noted in both study groups. Hygiene index scores for Group 2 (the primary group) differed statistically significantly upon initial application of the procedure and demonstrated the high effectiveness of the protocol on days 2 and 5 of observation (p<0.0001).
Ключевые Слова
гигиена полости рта, критические пациенты, хлоргексидин, зубной налет, ИВЛ.
Ключевые Слова (англ)
Оral hygiene, critical patients, chlorhexidine, dental plaque, mechanical ventilation.
Список литературы
1. World Health Organization, 2022, Global oral health status report: Towards universal health coverage for oral health by 2030. Available from:
https://www.who.int/publications/i/item/9789240061484.
2. Valm A.M. (2019). The Structure of Dental Plaque Microbial Communities in the Transition from Health to Dental Caries and Periodontal Disease. Journal of molecular biology, 431(16), 2957-2969. https://doi.org/10.1016/j.jmb.2019.05.016.
3. Kholy, K.E., Genco, R.J., & Van Dyke, T.E. (2015). Oral infections and cardiovascular disease. Trends in endocrinology and metabolism: TEM, 26(6), 315-321. https://doi.org/10.1016/j.tem.2015.03.001.
4. Mukherjee, A., Jantsch, V., Khan, R., Hartung, W., Fischer, R., Jantsch, J., Ehrenstein, B., Konig, M.F., & Andrade, F. (2018). Rheumatoid Arthritis-Associated Autoimmunity Due to Aggregatibacter actinomycetemcomitans and Its Resolution With Antibiotic Therapy. Frontiers in immunology, 9, 2352. https://doi.org/10.3389/fimmu.2018.02352.
5. Влияние различных протоколов гигиены полости рта критических пациентов на Pseudomonas aeruginosa - возбудителя пневмонии, ассоциированной с искусственной вентиляцией лёгких: рандомизированное контролируемое исследование / М.Д.Байкулова, С.Н.Разумова, А.С.Браго, Н.В.Утц // Российский стоматологический журнал. - 2025. - Т. 29, № 6. - С. 461-467. - DOI 10.17816/dent695855. - EDN OPRRVQ.
6. Zygmunt, Ł., Kiryk, S., Wesołek, K., Kiryk, J., Nawrot-Hadzik, I., Rybak, Z., Sztyler, K., Małyszek, A., Matys, J., & Dobrzyński, M. (2025). The Role of the Oral Microbiome and Dental Caries in Respiratory Health: A Systematic Review. Journal of clinical medicine, 14(21), 7670. https://doi.org/10.3390/jcm14217670.
7. Sreenivasan, V.P.D., Ganganna, A., & Rajashekaraiah, P.B. (2018). Awareness among intensive care nurses regarding oral care in critically ill patients. Journal of Indian Society of Periodontology, 22(6), 541-545. https://doi.org/10.4103/jisp.jisp_30_18.
8. Baykulova M.D., Razumova S.N., Brago A.S., Utz N.V., Barakat H.B., Razumov NM, Myandiev MS. Oral hygiene for severe care: a literature review. Russian Journal of Dentistry. 2024;28(4):420-431. DOI: https://doi.org/10.17816/dent633055.
9. Silvestri, L., Weir, I., Gregori, D., Taylor, N., Zandstra, D., Van Saene, J.J., & Van Saene, H.K. (2014). Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative micro-organisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva anestesiologica, 80(7), 805-820.
10. Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H.V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 12(12), CD008367. https://doi.org/10.1002/14651858.CD008367.pub4.
11. Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3.
REFERENCES:
1. World Health Organization, 2022, Global oral health status report: Towards universal health coverage for oral health by 2030. Available from: https://www.who.int/publications/i/item/9789240061484.
2. Valm A.M. (2019). The Structure of Dental Plaque Microbial Communities in the Transition from Health to Dental Caries and Periodontal Disease. Journal of molecular biology, 431(16), 2957-2969. https://doi.org/10.1016/j.jmb.2019.05.016.
3. Kholy, K.E., Genco, R.J., & Van Dyke, T.E. (2015). Oral infections and cardiovascular disease. Trends in endocrinology and metabolism: TEM, 26(6), 315-321. https://doi.org/10.1016/j.tem.2015.03.001.
4. Mukherjee, A., Jantsch, V., Khan, R., Hartung, W., Fischer, R., Jantsch, J., Ehrenstein, B., Konig, M.F., & Andrade, F. (2018). Rheumatoid Arthritis-Associated Autoimmunity Due to Aggregatibacter actinomycetemcomitans and Its Resolution With Antibiotic Therapy. Frontiers in immunology, 9, 2352. https://doi.org/10.3389/fimmu.2018.02352.
5. Vliyanie razlichnyh protokolov gigieny polosti rta kriticheskih pacientov na Pseudomonas aeruginosa - vozbuditelya pnevmonii, associirovannoj s iskusstvennoj ventilyaciej lyogkih: randomizirovannoe kontroliruemoe issledovanie / M.D.Bajkulova, S.N.Razumova, A.S.Brago, N.V.Utc // Rossijskij stomatologicheskij zhurnal. - 2025. - T. 29, № 6. - S. 461-467. - DOI 10.17816/dent695855. - EDN OPRRVQ.
6. Zygmunt, Ł., Kiryk, S., Wesołek, K., Kiryk, J., Nawrot-Hadzik, I., Rybak, Z., Sztyler, K., Małyszek, A., Matys, J., & Dobrzyński, M. (2025). The Role of the Oral Microbiome and Dental Caries in Respiratory Health: A Systematic Review. Journal of clinical medicine, 14(21), 7670. https://doi.org/10.3390/jcm14217670.
7. Sreenivasan, V.P.D., Ganganna, A., & Rajashekaraiah, P.B. (2018). Awareness among intensive care nurses regarding oral care in critically ill patients. Journal of Indian Society of Periodontology, 22(6), 541-545. https://doi.org/10.4103/jisp.jisp_30_18.
8. Baykulova M.D., Razumova S.N., Brago A.S., Utz N.V., Barakat H.B., Razumov NM, Myandiev MS. Oral hygiene for severe care: a literature review. Russian Journal of Dentistry. 2024;28(4):420-431. DOI: https://doi.org/10.17816/dent633055.
9. Silvestri, L., Weir, I., Gregori, D., Taylor, N., Zandstra, D., Van Saene, J.J., & Van Saene, H.K. (2014). Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative micro-organisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva anestesiologica, 80(7), 805-820.
10. Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H.V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 12(12), CD008367. https://doi.org/10.1002/14651858.CD008367.pub4.
11. Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3.
2. Valm A.M. (2019). The Structure of Dental Plaque Microbial Communities in the Transition from Health to Dental Caries and Periodontal Disease. Journal of molecular biology, 431(16), 2957-2969. https://doi.org/10.1016/j.jmb.2019.05.016.
3. Kholy, K.E., Genco, R.J., & Van Dyke, T.E. (2015). Oral infections and cardiovascular disease. Trends in endocrinology and metabolism: TEM, 26(6), 315-321. https://doi.org/10.1016/j.tem.2015.03.001.
4. Mukherjee, A., Jantsch, V., Khan, R., Hartung, W., Fischer, R., Jantsch, J., Ehrenstein, B., Konig, M.F., & Andrade, F. (2018). Rheumatoid Arthritis-Associated Autoimmunity Due to Aggregatibacter actinomycetemcomitans and Its Resolution With Antibiotic Therapy. Frontiers in immunology, 9, 2352. https://doi.org/10.3389/fimmu.2018.02352.
5. Влияние различных протоколов гигиены полости рта критических пациентов на Pseudomonas aeruginosa - возбудителя пневмонии, ассоциированной с искусственной вентиляцией лёгких: рандомизированное контролируемое исследование / М.Д.Байкулова, С.Н.Разумова, А.С.Браго, Н.В.Утц // Российский стоматологический журнал. - 2025. - Т. 29, № 6. - С. 461-467. - DOI 10.17816/dent695855. - EDN OPRRVQ.
6. Zygmunt, Ł., Kiryk, S., Wesołek, K., Kiryk, J., Nawrot-Hadzik, I., Rybak, Z., Sztyler, K., Małyszek, A., Matys, J., & Dobrzyński, M. (2025). The Role of the Oral Microbiome and Dental Caries in Respiratory Health: A Systematic Review. Journal of clinical medicine, 14(21), 7670. https://doi.org/10.3390/jcm14217670.
7. Sreenivasan, V.P.D., Ganganna, A., & Rajashekaraiah, P.B. (2018). Awareness among intensive care nurses regarding oral care in critically ill patients. Journal of Indian Society of Periodontology, 22(6), 541-545. https://doi.org/10.4103/jisp.jisp_30_18.
8. Baykulova M.D., Razumova S.N., Brago A.S., Utz N.V., Barakat H.B., Razumov NM, Myandiev MS. Oral hygiene for severe care: a literature review. Russian Journal of Dentistry. 2024;28(4):420-431. DOI: https://doi.org/10.17816/dent633055.
9. Silvestri, L., Weir, I., Gregori, D., Taylor, N., Zandstra, D., Van Saene, J.J., & Van Saene, H.K. (2014). Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative micro-organisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva anestesiologica, 80(7), 805-820.
10. Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H.V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 12(12), CD008367. https://doi.org/10.1002/14651858.CD008367.pub4.
11. Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3.
REFERENCES:
1. World Health Organization, 2022, Global oral health status report: Towards universal health coverage for oral health by 2030. Available from: https://www.who.int/publications/i/item/9789240061484.
2. Valm A.M. (2019). The Structure of Dental Plaque Microbial Communities in the Transition from Health to Dental Caries and Periodontal Disease. Journal of molecular biology, 431(16), 2957-2969. https://doi.org/10.1016/j.jmb.2019.05.016.
3. Kholy, K.E., Genco, R.J., & Van Dyke, T.E. (2015). Oral infections and cardiovascular disease. Trends in endocrinology and metabolism: TEM, 26(6), 315-321. https://doi.org/10.1016/j.tem.2015.03.001.
4. Mukherjee, A., Jantsch, V., Khan, R., Hartung, W., Fischer, R., Jantsch, J., Ehrenstein, B., Konig, M.F., & Andrade, F. (2018). Rheumatoid Arthritis-Associated Autoimmunity Due to Aggregatibacter actinomycetemcomitans and Its Resolution With Antibiotic Therapy. Frontiers in immunology, 9, 2352. https://doi.org/10.3389/fimmu.2018.02352.
5. Vliyanie razlichnyh protokolov gigieny polosti rta kriticheskih pacientov na Pseudomonas aeruginosa - vozbuditelya pnevmonii, associirovannoj s iskusstvennoj ventilyaciej lyogkih: randomizirovannoe kontroliruemoe issledovanie / M.D.Bajkulova, S.N.Razumova, A.S.Brago, N.V.Utc // Rossijskij stomatologicheskij zhurnal. - 2025. - T. 29, № 6. - S. 461-467. - DOI 10.17816/dent695855. - EDN OPRRVQ.
6. Zygmunt, Ł., Kiryk, S., Wesołek, K., Kiryk, J., Nawrot-Hadzik, I., Rybak, Z., Sztyler, K., Małyszek, A., Matys, J., & Dobrzyński, M. (2025). The Role of the Oral Microbiome and Dental Caries in Respiratory Health: A Systematic Review. Journal of clinical medicine, 14(21), 7670. https://doi.org/10.3390/jcm14217670.
7. Sreenivasan, V.P.D., Ganganna, A., & Rajashekaraiah, P.B. (2018). Awareness among intensive care nurses regarding oral care in critically ill patients. Journal of Indian Society of Periodontology, 22(6), 541-545. https://doi.org/10.4103/jisp.jisp_30_18.
8. Baykulova M.D., Razumova S.N., Brago A.S., Utz N.V., Barakat H.B., Razumov NM, Myandiev MS. Oral hygiene for severe care: a literature review. Russian Journal of Dentistry. 2024;28(4):420-431. DOI: https://doi.org/10.17816/dent633055.
9. Silvestri, L., Weir, I., Gregori, D., Taylor, N., Zandstra, D., Van Saene, J.J., & Van Saene, H.K. (2014). Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative micro-organisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva anestesiologica, 80(7), 805-820.
10. Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H.V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 12(12), CD008367. https://doi.org/10.1002/14651858.CD008367.pub4.
11. Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3.
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