针对获得性脑损伤的吞咽困难、依赖护理患者的个体化口腔保健：一项整群非随机对照试验的探索性预设亚组分析
Individualized Oral Health Care for Dysphagic, Care-Dependent Patients With Acquired Brain Injury: An Exploratory Predefined Subgroup Analysis of a Cluster Nonrandomized Controlled Trial.
文献信息
| PMID | 42705841 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mohit Kothari |
| 作者单位 | Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark. |
| 期刊 | Journal of oral rehabilitation |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 吞咽困难个体表现出 impaired oral clearance 和 reduced airway protection，增加口腔生物膜积累和炎症负担。
目的： 评估结构化、个体化口腔护理方法（MOHIT）是否与吞咽困难、依赖护理的获得性脑损伤（ABI）患者在住院神经康复期间口腔炎症和生物膜相关标志物的变化相关。
方法： 在整群非随机对照试验的探索性预设亚组分析中，第1周筛查为吞咽困难阳性的ABI成人（n=44）被随访3周。三个病房实施结构化、个体化口腔护理方案（MOHIT：n=12），包括结构化口腔评估和个体化护士提供的口腔护理（包括 suction-assisted electric toothbrushing），而三个病房继续标准口腔护理（EOCP：n=32）。结局包括行为指标（刷牙频率和牙刷类型）、改良床边口腔检查（mBOE）和临床参数（菌斑、探诊出血、舌苔和气味），在基线和第4周评估。变化方向指标使用Mann-Whitney U检验进行比较。
结果： 两组间刷牙频率无差异（p=0.347）。MOHIT组在整体mBOE评分（3.1±2.2 vs. 0.8±2.8；p=0.007）、探诊出血（22.7±22.3 vs. -4.0±20.2；p=0.001）、菌斑（20.1±14.0 vs. 2.7±17.4；p=0.009）和气味评分（1.6±1.7 vs. 0.3±1.4；p=0.019）方面显示出更有利的探索性变化。舌苔评分显示出有利但非显著的探索性趋势（6.2±5.5 vs. 1.4±6.6；p=0.057）。
结论： 由 trained nursing staff 提供的结构化、个体化口腔护理与吞咽困难、依赖护理的ABI个体筛查和临床炎症标志物的改善相关。鉴于整群层面的实施、小样本量和非随机分配，研究结果表明可行性，并支持潜在临床益处的假设生成证据，但未确立因果疗效。
英文摘要
BACKGROUND: Individuals with dysphagia exhibit impaired oral clearance and reduced airway protection, increasing oral biofilm accumulation and inflammatory burden.
OBJECTIVE: To evaluate whether a structured, individualized oral care approach (MOHIT) was associated with changes in oral inflammatory and biofilm-related markers in dysphagic, care-dependent individuals with acquired brain injury (ABI) during inpatient neurorehabilitation.
METHODS: Adults with ABI, who screened positive for dysphagia at week 1 (n = 44) were followed for 3 weeks in an exploratory predefined subgroup analysis of a cluster nonrandomized controlled trial. Three wards implemented a structured, individualized oral care protocol (MOHIT: n = 12), consisting of structured oral assessment and individualized nurse-delivered oral care including suction-assisted electric toothbrushing, while three wards continued standard oral care (EOCP: n = 32). Outcomes included behavioural indicators (brushing frequency and toothbrush type), modified Bedside Oral Examination (mBOE), and clinical parameters (plaque, bleeding on probing, tongue coating, and odour) assessed at baseline and week 4. Direction-of-change indicators were compared using the Mann-Whitney U test.
RESULTS: Toothbrushing frequency did not differ between groups (p = 0.347). The MOHIT group showed more favourable exploratory changes in overall mBOE score (3.1 ± 2.2 vs. 0.8 ± 2.8; p = 0.007), bleeding on probing (22.7 ± 22.3 vs. -4.0 ± 20.2; p = 0.001), plaque (20.1 ± 14.0 vs. 2.7 ± 17.4; p = 0.009), and odour score (1.6 ± 1.7 vs. 0.3 ± 1.4; p = 0.019). Tongue-coating score showed a favourable but non-significant exploratory pattern (6.2 ± 5.5 vs. 1.4 ± 6.6; p = 0.057).
CONCLUSION: Structured, individualized oral care delivered by trained nursing staff was associated with improvements in screening and clinical inflammatory markers among dysphagic, care-dependent ABI individuals. Given the cluster-level implementation, small sample size, and nonrandomized allocation, findings indicate feasibility and support hypothesis-generating evidence of potential clinical benefit but do not establish causal efficacy.