背　景口腔護理可能有助於降低肺炎發生並增進口腔健康及衛生。然鮮少有臨床試驗探討刷牙是否可以減少呼吸器相關肺炎，並改善口腔健康及衛生。目　的研究目的在於探討每日兩次純水刷牙，是否可以降低神經外科加護病房病患呼吸器相關肺炎的發生率，並改善口腔健康及衛生。方　法本研究為隨機之臨床前驅試驗。將新北市某醫學中心神經外科加護病房新入住病患，依據⑴使用呼吸器至少48~72小時、且⑵未感染肺炎的條件，共收案53位並隨機分配至實驗與對照兩組。除病房常規外，實驗組接受一天兩次，包括搖高床頭、深部口咽抽吸、及以純水（逆滲透水）和牙刷清潔口腔的口腔護理。對照組也接受包括搖高床頭、深部口咽抽吸、及以純水潤濕口腔，一天兩次的仿實驗組類口腔護理。呼吸器相關肺炎發生，則依據肺部感染指標大於6分來判定；口腔健康及衛生則以相關量表評估。結　果53位個案中，大多接受緊急手術（75.5%），平均年齡為60.6歲，其中有64.2%為男性。呼吸器相關肺炎發生率在實驗組（17%）顯著低於對照組的71%（p < .05）。實驗組的口腔健康及衛生狀態，不論在口腔健康量表（p < .05）或牙菌斑得分（p < .01）均顯著優於對照組。結　論／實務應用研究結果顯示，每日兩次純水刷牙的口腔護理，可有效降低呼吸器相關肺炎的發生率，並改善口腔健康及衛生。

Background: Oral care may decrease the development of ventilator-associated pneumonia (VAP) and improve oral hygiene. However, little evidence is available to guide the development of oral care protocols. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive.Purpose: This study evaluated the effects in postneurosurgical,intensive care unit patients of brushing teeth twice daily with purified water on VAP rates and oral health or hygiene.Methods: This study conducted a randomized controlled pilot
trial. Patients consecutively admitted to the surgical intensive
care unit at a suburban hospital in 2007 were invited to participate
if they met two inclusion criteria: (a) under ventilator support for at least 48 to 72 hours and (b) no current pneumonia.Upon obtaining informed consent, subjects were randomized into experimental and control groups. Both groups received usual hospital care, that is, daily oral care using cotton swabs. The experimental group additionally received a twicedaily
oral care protocol of toothbrushing with purified water,elevating the head of the bed, and before-and-after hypopharyngeal suctioning. The control group also received twice-daily mock oral care (elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning). VAP was defined by a clinical pulmonary infection score of 9 6. Oral hygiene and health was assessed after conclusion of the intervention.Results: Patients (N = 53) were predominantly male (64.2%),mean age was 60.6 years old, and most had received emergency surgery (75.5%). After 7 days of toothbrushing with
purified water, cumulative VAP rates were significantly lower in the experimental (17%) than in the control (71%; p G.05)group. The experimental group also had significantly better scores for oral health (p G.05) and plaque index (p G.01).Conclusion/Implication for Practice: Findings suggest that,as an inexpensive alternative to existing protocols, toothbrushing twice daily with purified water reduces VAP and improves oral health and hygiene.