循证视角下脑卒中吞咽障碍患者护理管理方案及效果评价

王兰珍; 徐利萍; 徐淑芬; 胡军; 徐慧霞; 陈梅琴

doi:10.16766/j.cnki.issn.1674-4152.001848

循证视角下脑卒中吞咽障碍患者护理管理方案及效果评价

doi: 10.16766/j.cnki.issn.1674-4152.001848

1.
衢州市人民医院神经内科，浙江衢州 324000
2.
衢州市人民医院感染科，浙江衢州 324000

基金项目:

浙江省医药卫生科技计划项目 2020KY1023

详细信息

通讯作者:
徐利萍，E-mail：ye879464@163.com

中图分类号: R473.5 R743
计量
- 文章访问数: 177
- HTML全文浏览量: 178
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-17
- 网络出版日期: 2022-02-19

Nursing management plan and effect evaluation of stroke patients with dysphagia from the evidence-based perspective

1.
Department of Neurology, Quzhou City People's Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的分析循证视角下构建脑卒中吞咽障碍患者的护理管理方案具体措施，并评价对脑卒中吞咽障碍患者应用循证护理的效果。方法便利抽样法选取2018年1—12月衢州市人民医院收治的脑卒中患者821例作为对照组，选取2019年1—12月衢州市人民医院收治的脑卒中患者829例作为观察组。对照组应用常规护理，观察组应用循证视角下构建的护理管理方案。比较2组患者留置胃管率、胃管留置时间及卒中后肺炎发生率，比较2组患者护理干预前后吞咽功能。结果对照组患者留置胃管率为25.2%，高于观察组(15.9%)，观察组留置胃管时长为(6.28±1.54)d，短于对照组[(7.02±2.31)d]，对照组患者卒中后肺炎发生率为5.0%，明显高于观察组(2.9%)，比较差异均具有统计学意义(均P < 0.05)；护理干预前，2组患者标准吞咽功能评分(SSA)比较差异无统计学意义(均P>0.05)，护理干预后，观察组吞咽功能各项评分优于对照组，差异具有统计学意义(均P < 0.05)。结论循证视角下实施护理管理方案更有利于降低脑卒中吞咽障碍患者留置胃管及卒中后肺炎发生率，且明显改善患者吞咽功能。
- 循证视角 /
- 脑卒中 /
- 吞咽功能障碍 /
- 护理管理 /
- 效果
Abstract: Objective To analyze the specific measures to construct the nursing management scheme of stroke patients with dysphagia from the perspective of evidence-based, and analyze the effect evaluation of applying evidence-based nursing to stroke patients with dysphagia. Methods Total 821 cases of stroke patients in our hospital from January 2018 to December 2018 were selected as the control group, and 829 cases of stroke patients in our hospital from January 2019 to December 2019 were selected as the observation group. Patients in the control group were treated with routine nursing program, while patients in the observation group were treated with nursing management scheme constructed from the evidence-based perspective. The rate of indwelling gastric tube, indwelling time of gastric tube and incidence of pneumonia after stroke were compared between the two groups. Results The retention rate was 25.2% in the control group. The length of indwelling gastric tube in the observation group was (6.28±1.54) d, shorter than that in the control group (7.02±2.31). The incidence of pneumonia after stroke in the control group was 5.0%, significantly higher than 2.9% of the patients in the observation group (P < 0.05). Before the intervention, there was no significant difference in standard swallowing function score (SSA) between the two groups (P>0.05). After nursing intervention, the scores of swallowing functions in the observation group were better than those in the control group, differences were statistically significant (P < 0.05). Conclusion The implementation of evidence-based nursing management program is more conducive to reduce the incidence of indwelling gastric tube and post-stroke pneumonia in patients with dysphagia after stroke, and significantly improve the swallowing function of patients, which is worthy of clinical application.
- Evidence-based perspective /
- Stroke /
- Swallowing dysfunction /
- Nursing management /
- Effect

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表 1 2组脑卒中患者胃管留置率及胃管留置时间比较

组别	例数	胃管留置[例(%)]	胃管留置时间(x±s，d)
对照组	821	207(25.2)	7.02±2.31
观察组	829	132(15.9)	6.28±1.54
统计量		21.809^a	7.663^b
P值		＜0.001	＜0.001
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中患者护理前后SSA评分比较(x±s，分)

组别	例数	头部/躯干控制		意识水平		咽反射		声音强弱		自主咳嗽		唇闭合
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	821	2.75±0.21	2.44±0.13^a	1.51±0.14	1.22±0.13^a	2.37±0.35	1.96±0.28^a	2.28±0.11	2.02±0.33^a	2.41±0.31	2.21±0.35^a	1.77±0.13	0.88±0.09^a
观察组	829	2.74±0.19	2.61±0.17^a	1.50±0.18	1.30±0.11^a	2.38±0.36	2.13±0.27^a	2.29±0.14	2.01±0.30^a	2.42±0.29	2.24±0.29^a	1.76±0.41	0.89±0.07^a
t值		1.014	22.801	1.259	13.499	0.572	12.554	1.612	0.644	0.677	1.897	0.666	2.521
P值		0.311	＜0.001	0.208	＜0.001	0.567	＜0.001	0.107	0.520	0.499	0.058	0.506	0.012

组别	例数	音质		呼吸方式		5 mL水吞咽状态		60 mL水吞咽状态		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前		干预后
对照组	821	2.18±0.21	1.59±0.13^a	1.64±0.13	1.32±0.10^a	9.63±1.14	7.83±1.10^a	10.65±1.17	9.06±1.33^a	37.46±4.55		26.78±3.81^a
观察组	829	2.19±0.20	1.60±0.11^a	1.65±0.11	1.41±0.25^a	9.62±1.15	8.26±1.28^a	10.68±1.24	9.27±1.26^a	37.51±4.63		27.20±3.84^a
t值		0.991	1.687	1.687	9.584	0.177	7.315	0.505	3.293	0.221		2.230
P值		0.322	0.092	0.092	＜0.001	0.860	＜0.001	0.614	0.001	0.825		0.026
注：与同组护理前比较，^aP < 0.05。

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