Construction of an Integrated Oral Care and Swallowing Stimulation Protocol for Comatose Patients with Cerebral Hemorrhage

Abstract

Objective: This study aims to design and establish a comprehensive intervention protocol that combines oral care with swallowing stimulation for comatose patients with cerebral hemorrhage. The core objectives are to systematically control the risk of aspiration pneumonia, improve the oral health environment of patients, and explore its potential supportive role in the early awakening process. Methods: The study was conducted using a mixed-methods approach. The first phase involved integrating systematic literature reviews with Delphi expert consultations to establish the basic components and specific operational norms of the protocol. The second phase implemented a non-randomized concurrent controlled clinical trial, enrolling 112 eligible comatose patients with cerebral hemorrhage, evenly divided into an intervention group and a control group, with 56 patients in each group. The intervention group received a newly constructed integrated protocol of oral care and swallowing stimulation for four weeks, while the control group maintained standard oral care routines in the neurology department. The core observational indicators included the Clinical Pulmonary Infection Score (CPIS), Oral Assessment Scale (OAS) scores, changes in the Glasgow Coma Scale (GCS) scores, and analysis of microbial colony counts in saliva. Data were analyzed using SPSS 25.0 software, with continuous variables conforming to a normal distribution presented as mean ± standard deviation. Comparisons between groups were made using independent sample t-tests or non-parametric Mann-Whitney U tests, and repeated measures analysis of variance was used for repeated measurement indicators. Results: After the four-week intervention period, data analysis revealed that the CPIS values in the intervention group were significantly lower than those in the control group, with statistical significance. In terms of oral health assessment, the intervention group showed significantly greater improvement than the control group. The intervention group also demonstrated a more pronounced upward trend in consciousness level scores. Microbiological test results confirmed that the survival numbers of opportunistic pathogens in the saliva of the intervention group were effectively controlled. Conclusion: The integrated protocol of oral care combined with swallowing stimulation constructed and preliminarily validated in this study has been shown to effectively reduce the clinical probability of aspiration pneumonia in comatose patients with cerebral hemorrhage, optimize oral microecological balance, and potentially promote improvement in consciousness status. This protocol holds potential value for translation into routine clinical practice.