多学科团队合作改善卒中后吞咽障碍患者营养状况的实践
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摘要
目的 :分析多学科团队改善卒中后吞咽障碍患者营养状况的效果。方法:成立多学科合作团队,分析目前我院卒中后营养管理存在的问题,完善营养评估流程,规范营养管理方案,完善质量控制体系;比较实施多学科团队改善卒中后吞咽障碍患者营养状况干预前后患者营养状态的相关指标。结果 :护士对患者营养风险筛查率达到100%;患者出院6个月后,干预实施前后两组患者营养风险评估得分、体质指数差异均具有统计学意义(P<0.05)。结论 :多学科团队能改善卒中后吞咽障碍患者营养状况。
Objective: To analyze effects of multidisciplinary team management on improving nutritional status in patients with post-stroke dysphagia. Methods: We established multidisciplinary collaborative team and based on the existing problems of nutritional management in post-stroke patients, we modified nutrition assessment process, standardized the nutrition management program and improved the quality control system. Nutritional indicators of stroke patients with dysphagia before and after intervention by multidisciplinary team were compared. Results: The nutritional screening rate was 100%. Six months after discharge, there were statistically significant differences in NRS scores and BMI between the two groups(P<0.05). Conclusion: Multidisciplinary collaborative team can improve the nutritional status in patients with post-stroke dysphagia.
Objective: To analyze effects of multidisciplinary team management on improving nutritional status in patients with post-stroke dysphagia. Methods: We established multidisciplinary collaborative team and based on the existing problems of nutritional management in post-stroke patients, we modified nutrition assessment process, standardized the nutrition management program and improved the quality control system. Nutritional indicators of stroke patients with dysphagia before and after intervention by multidisciplinary team were compared. Results: The nutritional screening rate was 100%. Six months after discharge, there were statistically significant differences in NRS scores and BMI between the two groups(P<0.05). Conclusion: Multidisciplinary collaborative team can improve the nutritional status in patients with post-stroke dysphagia.
引文
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[2] Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia:a review and design considerations for future trials. Int J Stroke, 2016,11(4):399-411.
[3] Corrigan ML, Escuro AA, Celestin J, et al.Nutrition in the stroke patient. Nutr Clin Pract,2011, 6(26):242-252.
[4] Mosselman MJ,Kruitwagen CL, Schuurmans MJ, et al. Malnutrition and risk of malnutrition in patients with stroke:prevalence during hospital stay. J Neurosci Nurs, 2013,3(45):194-204.
[5]HutchinsonE,WilsonN.Acutestroke,dysphagia and nutritional support. Br J Community Nurs, 2013(Suppl 5):S26-S29.
[6] Foley NC, Martin RE, Salter KL, et al. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med,2009,9(41):707-713.
[7]邝景云,彭伟英,李美琼,等.吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用.护理学杂志,2011,26(9):25-27.Kuang JY, Peng WY, Li MQ, et al. Effect of deglutition disorder test on aspiration pneumonia prevention in acute stroke patients. Journal of Nursing Science, 2011,26(9):25-27.
[8]柏慧华,姚秋进,祝晓娟,等.脑出血患者术后早期吞咽障碍筛查及康复护理.中华护理杂志,2013,48(4):299-301.Bai HH, Yao QJ, Zhu XJ, et al. Dysphagia screening and rehabilitation nursing of cerebral hemorrhage patients in postoperative early stage.Chinese Journal ofNursing, 2013,48(4):299-301.
[9] Sura L, Madhavan A,Carnaby G,et al.Dysphagiaintheelderly:managementand nutritional considerations. Clin Interv Aging,2012(7):287-298.
[10]中国卒中吞咽障碍与营养管理专家组.中国卒中吞咽障碍与营养管理手册.中国卒中杂志,2017,12(9):950-967.Expert Group on Chinese Stroke Swallow Disorders and Nutrition Management. Handbook on Chinese stroke swallowing and nutrition management. Chinese Journal of Stroke, 2017,12(9):950-967.
[11] Palli C, Fandler S, Doppelhofer K, et al. Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients. Stroke, 2017,9(28):2583-2585.
[12] Franceen K, Anna-Maria S, Matthew RH.Promotingshareddecision-makingin rehabilitation:development of a framework for situations when patients with dysphagia refuse diet modification recommended by the treating team. Dysphagia, 2012,27(1):81-87.
[13]中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018.中华神经科杂志,2018,51(9):666-682.Society of Neurology of Chinese Medical Association Group of Cerebrovascular disease in Society of Neurology of Chinese Medical Association. Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018. Chinese Journal of Neurology, 2018,51(9):666-682.
[14] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional Risk Screening(NRS2002):a new method based on an analysis of controlled clinical trials1. Clin Nutr, 2003,22(3):321-336.
[15]Dietary guidelines for Americans 2015-2020.8th ed.(2016-01-07). http://health gov/dietaryguidelines/2015/resourles/2015-2020_Dietary_Gudielines.pdf.
[16]中华医学会.临床诊疗指南-肠外肠内营养学分册.北京:人民卫生出版社,2007:15-19.Chinese Medical Association.Clinical guideintestinal nutrition section. Beijing:People's Health Publishing House, 2007:15-19.
[17]张颐,蒋朱明.营养筛查、评定与干预是成人营养诊疗的关键步骤:美国肠外肠内营养学会(ASPEN)2011年临床指南.中国临床营养杂志,2012,20(5):261-268.Zhang Y, Jiang ZM. Nutrition screening,assessment and intervention are key steps in adult nutrition diagnosis and treatment:ASPEN Clinical Guide 2011.Chinese Journal of Clinical Nutrition, 2012,20(5):261-268.
[18] Clave P, Arreola V, Romea M, et al. Accuracy of the volume-viscosity swallow test for clinical screeningoforopharyngeldysphagiaand aspiration. Clin Nutr, 2008(27):806-815.
[19] Lakshminarayan K, Tsai AW, Tong X, et al.Utility of dysphagia screening results in predicting post-stroke pneumonia.Stroke, 2010,41(12):2849-2854.
[20]常红,赵洁,张诗涵,等.量化食物稠度对减少脑卒中吞咽障碍患者误吸的效果评价.中华护理杂志,2018,53(1):31-35.Chang H, Zhao J, Zhang SH, et al. Evaluation of effects of quantification of food thickness on prevention of aspiration in stroke patients with dysphagia. Chinese Journal of Nursing, 2018,53(1):31-35.
[21] Campbell GB, Carter T, Kring D, et al.Nursing bedside dysphagia screen:is it valid?. J Neurosci Nurs, 2016,48(2):75-79.
[22]刘萍,欧翠玲,敖友爱,等.早期评估与分级管理的康复护理模式对脑卒中后吞咽功能及误吸的影响.中华物理医学与康复杂志,2017,39(12):934-936.Liu P, Ou CL, Ao YA, et al. Effect of early evaluationandhierarchicalmanagementof rehabilitation nursing model for swallowing function after stroke. Chin J Phys Med Rehabil,2017,39(12):934-936.
[23] Werner H. The benefits of the dysphagia clinical nurse specialist role. J Neurosci Nurs,2005,37(4):212-215.
[24] Geeganage C, Beavan J, Ellender S,et al.Intervention for dysphagia and nutritional support in acute and subacute stroke.(2012-10-7).http://onlinelibrary.wiley.com/.
[25]黄莉,文国强,赵仲艳,等.吞咽障碍筛查与前瞻性干预对神经内科住院患者吸入性肺部感染的影响研究.中华医院感染学杂志,2017,27(20):4685-4688.Huang L, Wen GQ, Zhao ZY, et al. Effects of dysphagia screening and prospective intervention on inhalation pulmonary infections in hospitalized neurology patients. Chin J Nosocomiol, 2017,27(20):4685-4688.
[26]卞毅,张萍,骆翔.神经内科住院患者营养风险筛查及营养支持应用状况.内科急危重症杂志,2013,19(3):154-156.Bian Y, Zhang P, Luo X. Nutritional risk screening and application of nutritional support in hospitalized patients with neurological disorders.Internal Medicine Critical Journal, 2013,19(3):154-156.
[2] Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia:a review and design considerations for future trials. Int J Stroke, 2016,11(4):399-411.
[3] Corrigan ML, Escuro AA, Celestin J, et al.Nutrition in the stroke patient. Nutr Clin Pract,2011, 6(26):242-252.
[4] Mosselman MJ,Kruitwagen CL, Schuurmans MJ, et al. Malnutrition and risk of malnutrition in patients with stroke:prevalence during hospital stay. J Neurosci Nurs, 2013,3(45):194-204.
[5]HutchinsonE,WilsonN.Acutestroke,dysphagia and nutritional support. Br J Community Nurs, 2013(Suppl 5):S26-S29.
[6] Foley NC, Martin RE, Salter KL, et al. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med,2009,9(41):707-713.
[7]邝景云,彭伟英,李美琼,等.吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用.护理学杂志,2011,26(9):25-27.Kuang JY, Peng WY, Li MQ, et al. Effect of deglutition disorder test on aspiration pneumonia prevention in acute stroke patients. Journal of Nursing Science, 2011,26(9):25-27.
[8]柏慧华,姚秋进,祝晓娟,等.脑出血患者术后早期吞咽障碍筛查及康复护理.中华护理杂志,2013,48(4):299-301.Bai HH, Yao QJ, Zhu XJ, et al. Dysphagia screening and rehabilitation nursing of cerebral hemorrhage patients in postoperative early stage.Chinese Journal ofNursing, 2013,48(4):299-301.
[9] Sura L, Madhavan A,Carnaby G,et al.Dysphagiaintheelderly:managementand nutritional considerations. Clin Interv Aging,2012(7):287-298.
[10]中国卒中吞咽障碍与营养管理专家组.中国卒中吞咽障碍与营养管理手册.中国卒中杂志,2017,12(9):950-967.Expert Group on Chinese Stroke Swallow Disorders and Nutrition Management. Handbook on Chinese stroke swallowing and nutrition management. Chinese Journal of Stroke, 2017,12(9):950-967.
[11] Palli C, Fandler S, Doppelhofer K, et al. Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients. Stroke, 2017,9(28):2583-2585.
[12] Franceen K, Anna-Maria S, Matthew RH.Promotingshareddecision-makingin rehabilitation:development of a framework for situations when patients with dysphagia refuse diet modification recommended by the treating team. Dysphagia, 2012,27(1):81-87.
[13]中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018.中华神经科杂志,2018,51(9):666-682.Society of Neurology of Chinese Medical Association Group of Cerebrovascular disease in Society of Neurology of Chinese Medical Association. Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018. Chinese Journal of Neurology, 2018,51(9):666-682.
[14] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional Risk Screening(NRS2002):a new method based on an analysis of controlled clinical trials1. Clin Nutr, 2003,22(3):321-336.
[15]Dietary guidelines for Americans 2015-2020.8th ed.(2016-01-07). http://health gov/dietaryguidelines/2015/resourles/2015-2020_Dietary_Gudielines.pdf.
[16]中华医学会.临床诊疗指南-肠外肠内营养学分册.北京:人民卫生出版社,2007:15-19.Chinese Medical Association.Clinical guideintestinal nutrition section. Beijing:People's Health Publishing House, 2007:15-19.
[17]张颐,蒋朱明.营养筛查、评定与干预是成人营养诊疗的关键步骤:美国肠外肠内营养学会(ASPEN)2011年临床指南.中国临床营养杂志,2012,20(5):261-268.Zhang Y, Jiang ZM. Nutrition screening,assessment and intervention are key steps in adult nutrition diagnosis and treatment:ASPEN Clinical Guide 2011.Chinese Journal of Clinical Nutrition, 2012,20(5):261-268.
[18] Clave P, Arreola V, Romea M, et al. Accuracy of the volume-viscosity swallow test for clinical screeningoforopharyngeldysphagiaand aspiration. Clin Nutr, 2008(27):806-815.
[19] Lakshminarayan K, Tsai AW, Tong X, et al.Utility of dysphagia screening results in predicting post-stroke pneumonia.Stroke, 2010,41(12):2849-2854.
[20]常红,赵洁,张诗涵,等.量化食物稠度对减少脑卒中吞咽障碍患者误吸的效果评价.中华护理杂志,2018,53(1):31-35.Chang H, Zhao J, Zhang SH, et al. Evaluation of effects of quantification of food thickness on prevention of aspiration in stroke patients with dysphagia. Chinese Journal of Nursing, 2018,53(1):31-35.
[21] Campbell GB, Carter T, Kring D, et al.Nursing bedside dysphagia screen:is it valid?. J Neurosci Nurs, 2016,48(2):75-79.
[22]刘萍,欧翠玲,敖友爱,等.早期评估与分级管理的康复护理模式对脑卒中后吞咽功能及误吸的影响.中华物理医学与康复杂志,2017,39(12):934-936.Liu P, Ou CL, Ao YA, et al. Effect of early evaluationandhierarchicalmanagementof rehabilitation nursing model for swallowing function after stroke. Chin J Phys Med Rehabil,2017,39(12):934-936.
[23] Werner H. The benefits of the dysphagia clinical nurse specialist role. J Neurosci Nurs,2005,37(4):212-215.
[24] Geeganage C, Beavan J, Ellender S,et al.Intervention for dysphagia and nutritional support in acute and subacute stroke.(2012-10-7).http://onlinelibrary.wiley.com/.
[25]黄莉,文国强,赵仲艳,等.吞咽障碍筛查与前瞻性干预对神经内科住院患者吸入性肺部感染的影响研究.中华医院感染学杂志,2017,27(20):4685-4688.Huang L, Wen GQ, Zhao ZY, et al. Effects of dysphagia screening and prospective intervention on inhalation pulmonary infections in hospitalized neurology patients. Chin J Nosocomiol, 2017,27(20):4685-4688.
[26]卞毅,张萍,骆翔.神经内科住院患者营养风险筛查及营养支持应用状况.内科急危重症杂志,2013,19(3):154-156.Bian Y, Zhang P, Luo X. Nutritional risk screening and application of nutritional support in hospitalized patients with neurological disorders.Internal Medicine Critical Journal, 2013,19(3):154-156.
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