脑卒中吞咽障碍患者的摄食管理临床研究
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摘要
目的提高脑卒中吞咽障碍患者吞咽功能训练效果,降低卒中相关性肺炎发生率。方法将136例脑卒中吞咽障碍(洼田饮水试验Ⅱ～Ⅴ级)患者随机分为两组各68例。对照组行脑卒中吞咽障碍常规饮食护理;观察组采取食物稠度及一口量精细评估,制订个体化进食方案,动态评价与方案调整等措施进行摄食管理。结果观察组吞咽功能恢复程度显著优于对照组,卒中相关性肺炎发生率显著低于对照组(P<0.05,P<0.01)。结论精细评估、个体化护理及全程追踪可提高脑卒中吞咽障碍训练效果,降低相关并发症。
Objective To improve the efficacy of swallowing training and reduce the incidence of stroke-associated pneumonia in patients with post-stroke dysphagia.Methods Totally,136 stroke patients with stage Ⅱ-Ⅴ Water Swallow Test dysphagia were randomized into two groups,with 68 cases in each group.The control group was subjected to routine dietary nursing for dysphagia after stroke,while the observation group received feeding interventions,including accurately assessing food consistency and mouthful volume,formulating individualized feeding protocol,dynamically evaluating and adjusting feeding protocol,etc.Results The observation group had better swallowing function recovery and lower stroke-associated pneumonia rate compared with the control group(P<0.05,P<0.01).Conclusion Accurate assessment,individualized nursing and whole-process tracing can improve the efficacy of swallowing training and reduce complications in patients with post-stroke dysphagia.
Objective To improve the efficacy of swallowing training and reduce the incidence of stroke-associated pneumonia in patients with post-stroke dysphagia.Methods Totally,136 stroke patients with stage Ⅱ-Ⅴ Water Swallow Test dysphagia were randomized into two groups,with 68 cases in each group.The control group was subjected to routine dietary nursing for dysphagia after stroke,while the observation group received feeding interventions,including accurately assessing food consistency and mouthful volume,formulating individualized feeding protocol,dynamically evaluating and adjusting feeding protocol,etc.Results The observation group had better swallowing function recovery and lower stroke-associated pneumonia rate compared with the control group(P<0.05,P<0.01).Conclusion Accurate assessment,individualized nursing and whole-process tracing can improve the efficacy of swallowing training and reduce complications in patients with post-stroke dysphagia.
引文
[1]卒中相关性肺炎诊治中国专家共识组.卒中相关性肺炎诊治中国专家共识[J].中华内科杂志,2010,49(12):1075-1078.
[2]王岑立,康志浩,陈利斌,等.急性脑卒中相关性肺炎的病原菌分布及危险因素分析[J].中华医院感染学杂志,2014,24(7):1614-1617.
[3]Han G S,Byung-Mo O,Tai R H.Swallowing kinema-tics and factors associated with laryngeal penetration and aspiration in stroke survivors with dysphagia[J].Dysphagia,2015,21(11):1502-1511.
[4]廖喜琳,钟美容,蔡超群,等.标准吞咽功能评估及预见性护理对老年脑卒中患者康复的影响[J].中国老年学杂志,2015,35(4):2036-2038.
[5]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[J].护理学杂志,2011,26(9):25-26.
[6]陈菊娣,贾澄杰,张建飞,等.穴位冰刺激在脑卒中吞咽障碍患者吸入性肺炎预防护理中的应用[J].护理学杂志,2017,32(15):34-36.
[7]任琳,郎黎薇,殷志雯.增加吞咽功能筛查频次对减少桥小脑角肿瘤患者手术后吸入性肺炎的作用[J].中华护理杂志,2014,49(3):284-286.
[8]刘华华,蒋红,施煜,等.护士识别与管理脑卒中患者吞咽障碍的循证护理实践[J].护理学杂志,2016,31(17):51-54.
[9]常红,赵杰,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[J].中华护理杂志,2018,53(1):32-34.
[10]朱美红,时美芳,万里红,等.吞咽-摄食管理预防脑卒中吞咽障碍患者相关性肺炎的研究[J].中华护理杂志,2016,51(3):294-298.
[11]Ilott I,Bennett B,Gerrish K,et al.Evaluating a novel approach to enhancing dysphagia management:workplacebased,blended-leaning[J].J Clin Nurs,2014,23(9-10):1354-1364.
[12]中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)[J].中华物理医学与康复杂志,2017,39(12):881-892.
[13]卒中患者吞咽障碍和营养管理中国专家组.卒中患者吞咽障碍和营养管理的中国专家共识(2013版)[J].中国卒中杂志,2013,8(12):973-983.
[14]詹青,王丽晶.2016年美国AHA/ASA卒中康复指南解读[J].神经病学与神经康复学杂志,2017,13(1):1-9.
[15]王刚,黄葵.脑卒中吞咽障碍康复治疗进展[J].中国康复理论与实践,2016,22(2):160-162.
[16]李小寒.基础护理学[M].北京:人民卫生出版社,2017:315.
[17]曾西,范志诚,王德军,等.间歇口腔营养管进食对中度脑外伤患者吞咽功能及营养状况的影响[J].中华物理医学与康复杂志,2012,34(6):460-461.
[18]邓红琼,李宁.脑卒中后吞咽障碍的发生机制研究进展[J].中华老年心血管病杂志,2014,16(9):1000-1001.
[19]李敏,王峥,韩维嘉,等.糊状饮食对中度吞咽障碍老年患者营养状态及吞咽功能的影响[J].护理学报,2014,21(9):47-51.
[20]区洁崧,罗翠华,冯婉芬,等.经口至食管间歇置管对脑卒中咽期吞咽障碍的应用研究[J].全科护理,2018,16(12):1505-1507.
[21]李国平,杨玉峰,侯玉琴.经口间歇胃管置管治疗急性脑卒中后吞咽障碍疗效观察[J].中国实用神经疾病杂志,2015,18(24):127-128.
[22]王爱霞,刘延锦,董小方,等.间歇经口管饲法对脑卒中吞咽障碍患者舒适度及吞咽功能的影响[J].中华现代护理杂志,2018,24(3):305-308.
[2]王岑立,康志浩,陈利斌,等.急性脑卒中相关性肺炎的病原菌分布及危险因素分析[J].中华医院感染学杂志,2014,24(7):1614-1617.
[3]Han G S,Byung-Mo O,Tai R H.Swallowing kinema-tics and factors associated with laryngeal penetration and aspiration in stroke survivors with dysphagia[J].Dysphagia,2015,21(11):1502-1511.
[4]廖喜琳,钟美容,蔡超群,等.标准吞咽功能评估及预见性护理对老年脑卒中患者康复的影响[J].中国老年学杂志,2015,35(4):2036-2038.
[5]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[J].护理学杂志,2011,26(9):25-26.
[6]陈菊娣,贾澄杰,张建飞,等.穴位冰刺激在脑卒中吞咽障碍患者吸入性肺炎预防护理中的应用[J].护理学杂志,2017,32(15):34-36.
[7]任琳,郎黎薇,殷志雯.增加吞咽功能筛查频次对减少桥小脑角肿瘤患者手术后吸入性肺炎的作用[J].中华护理杂志,2014,49(3):284-286.
[8]刘华华,蒋红,施煜,等.护士识别与管理脑卒中患者吞咽障碍的循证护理实践[J].护理学杂志,2016,31(17):51-54.
[9]常红,赵杰,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[J].中华护理杂志,2018,53(1):32-34.
[10]朱美红,时美芳,万里红,等.吞咽-摄食管理预防脑卒中吞咽障碍患者相关性肺炎的研究[J].中华护理杂志,2016,51(3):294-298.
[11]Ilott I,Bennett B,Gerrish K,et al.Evaluating a novel approach to enhancing dysphagia management:workplacebased,blended-leaning[J].J Clin Nurs,2014,23(9-10):1354-1364.
[12]中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)[J].中华物理医学与康复杂志,2017,39(12):881-892.
[13]卒中患者吞咽障碍和营养管理中国专家组.卒中患者吞咽障碍和营养管理的中国专家共识(2013版)[J].中国卒中杂志,2013,8(12):973-983.
[14]詹青,王丽晶.2016年美国AHA/ASA卒中康复指南解读[J].神经病学与神经康复学杂志,2017,13(1):1-9.
[15]王刚,黄葵.脑卒中吞咽障碍康复治疗进展[J].中国康复理论与实践,2016,22(2):160-162.
[16]李小寒.基础护理学[M].北京:人民卫生出版社,2017:315.
[17]曾西,范志诚,王德军,等.间歇口腔营养管进食对中度脑外伤患者吞咽功能及营养状况的影响[J].中华物理医学与康复杂志,2012,34(6):460-461.
[18]邓红琼,李宁.脑卒中后吞咽障碍的发生机制研究进展[J].中华老年心血管病杂志,2014,16(9):1000-1001.
[19]李敏,王峥,韩维嘉,等.糊状饮食对中度吞咽障碍老年患者营养状态及吞咽功能的影响[J].护理学报,2014,21(9):47-51.
[20]区洁崧,罗翠华,冯婉芬,等.经口至食管间歇置管对脑卒中咽期吞咽障碍的应用研究[J].全科护理,2018,16(12):1505-1507.
[21]李国平,杨玉峰,侯玉琴.经口间歇胃管置管治疗急性脑卒中后吞咽障碍疗效观察[J].中国实用神经疾病杂志,2015,18(24):127-128.
[22]王爱霞,刘延锦,董小方,等.间歇经口管饲法对脑卒中吞咽障碍患者舒适度及吞咽功能的影响[J].中华现代护理杂志,2018,24(3):305-308.