多学科协作康复护理模式在脑卒中吞咽障碍患者中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2022.21.010

摘要/Abstract

摘要： 目的　探讨多学科协作康复护理模式在脑卒中吞咽障碍患者中的应用效果。方法　采取前瞻性研究，将驻马店市中心医院2019年3月至2022年3月收治的脑卒中吞咽障碍患者94例按随机数字表法分为对照组和观察组，各47例。对照组男24例，女23例，年龄（65.93±2.15）岁，采取常规护理；观察组男25例，女22例，年龄（65.89±2.13）岁，实施多学科协作康复护理；两组均持续护理4周。比较两组吞咽功能、心理状态、营养状况、并发症和生活质量。采用t、χ²检验。结果　观察组护理后吞咽功能优于对照组，差异有统计学意义（Z=3.398，P=0.001）。观察组护理后焦虑自评量表（SAS）评分为（38.46±2.15）分、抑郁自评量表（SDS）为（34.65±2.03）分，均低于对照组［（49.87±2.19）分、（40.83±2.06）分］，差异有统计学意义（t=25.488、14.649，均P<0.001）。观察组护理后血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（PA）水平分别为（120.76±12.94）g/L、（43.67±4.34）g/L、（255.72±20.69）mg/L，均高于对照组［（106.49±11.63）g/L、（39.67±4.30）g/L、（210.09±20.53）mg/L］，差异有统计学意义（t=5.623、4.489、10.733，均P<0.001）。观察组并发症发生率为4.26%（2/47），低于对照组的17.02%（8/47），差异有统计学意义（χ²=4.029，P=0.045）。观察组护理后脑卒中专用生活质量量表（SS-QOL）中精力、家庭活动、语言、活动能力、情绪、个性、自理能力、社会角色、思维、上肢功能、视力、工作评分分别为（11.18±1.36）分、（9.96±1.35）分、（16.89±2.54）分、（22.37±2.61）分、（16.87±2.38）分、（9.94±1.12）分、（18.96±2.43）分、（16.89±2.28）分、（11.28±1.39）分、（15.57±2.19）分、（10.24±1.18）分、（9.24±1.32）分，均高于对照组［（8.94±1.34）分、（6.84±1.21）分、（13.59±2.51）分、（18.96±2.57）分、（13.38±2.34）分、（6.92±1.05）分、（14.48±2.40）分、（13.57±2.24）分、（8.94±1.37）分、（12.38±2.17）分、（7.78±1.16）分、（6.98±1.30）分］，差异均有统计学意义（t=8.043、11.799、6.336、6.382、7.169、13.486、8.993、7.121、8.220、7.094、10.192、8.363，均P<0.001）。结论　脑卒中吞咽障碍患者实施多学科协作康复护理模式，可改善患者吞咽功能、不良情绪和营养状况，降低吸入性肺炎等并发症发生率，提升患者生活质量。

关键词: 脑卒中, 吞咽障碍, 多学科协作康复护理, 吞咽功能, 心理状态, 营养状况, 吸入性肺炎

Abstract: Objective　To explore the application effect of multidisciplinary collaborative rehabilitation nursing mode in stroke patients with dysphagia. Methods　A prospective study was conducted. A total of 94 stroke patients with dysphagia admitted to Zhumadian Central Hospital from March 2019 to March 2022 were divided into a control group and an observation group by the random number table method, with 47 cases in each group. The control group had 24 males and 23 females who were (65.93±2.15) years old, and took routine nursing for 4 weeks. The observation group had 25 males and 22 females who were (65.89±2.13) years old, and took multidisciplinary collaborative rehabilitation nursing for 4 weeks. The swallowing function, psychological states, nutritional status, complications, and quality of life in the two groups were compared. t andχ² tests were applied. Results　The swallowing function of the observation group after nursing was better than that of the control group, with a statistical difference (Z=3.398, P=0.001). The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) after nursing were (38.46±2.15) and (34.65±2.03) in the observation group, and were (49.87±2.19) and (40.83±2.06) in the control group, with statistical differences (t=25.488 and 14.649; both P<0.001). The levels of hemoglobin (Hb), albumin (ALB), and prealbumin (PA) after nursing were (120.76±12.94) g/L, (43.67±4.34) g/L, and (255.72±20.69) mg/L in the observation group, and were (106.49±11.63) g/L, (39.67±4.30) g/L, and (210.09±20.53) mg/L in the control group, with statistical differences (t=5.623, 4.489, and 10.733; all P<0.001). The incidence of complications in the observation group was lower than that in the control group [4.26% (2/47) vs. 17.02% (8/47)], with a statistically difference (χ²=4.029, P=0.045). The scores of energy, family activity, language, activity ability, emotion, personality, self-care ability, social role, thinking, upper limb function, vision, and work of Stroke-Specific Quality of Life Scale (SS-QOL) after nursing were (11.18±1.36), (9.96±1.35), (16.89±2.54), (22.37±2.61), (16.87±2.38), ( 9.94±1.12), (18.96±2.43), (16.89±2.28), (11.28±1.39), (15.57±2.19), (10.24±1.18), and (9.24±1.32) in the observation group, and were (8.94±1.34), (6.84±1.21), (13.59±2.51), (18.96±2.57), (13.38±2.34), (6.92±1.05), (14.48±2.40), (13.57±2.24), (8.94±1.37), (12.38±2.17), (7.78±1.16), and (6.98±1.30) in the control group, with statistical differences (t=8.043, 11.799, 6.336, 6.382, 7.169, 13.486, 8.993, 7.121, 8.220, 7.094, 10.192, and 8.363; all P<0.001). Conclusion　The multidisciplinary collaborative rehabilitation nursing mode for stroke patients with dysphagia can improve their swallowing function, adverse mood, nutritional status, and quality of life, and decrease the incidence of complications such as aspiration pneumonia.

Key words: Stroke, Dysphagia, Multidisciplinary collaborative rehabilitation nursing, Swallowing function, Psychological state, Nutritional status, Aspiration pneumonia

李亚如刘亚楠陈杰. 多学科协作康复护理模式在脑卒中吞咽障碍患者中的应用效果[J]. 国际医药卫生导报, 2022, 28(21): 3009-3013.

Li Yaru, Liu Yanan, Chen Jie. Application effect of multidisciplinary collaborative rehabilitation nursing mode in stroke patients with dysphagia [J]. International Medicine and Health Guidance News, 2022, 28(21): 3009-3013.

参考文献

[1] 陈名敏,龙宝珠.尿管球囊扩张联合早期呼吸训练治疗脑卒中后吞咽功能障碍的疗效[J].心血管康复医学杂志,2020,29(3):276-285. DOI:10.3969/j.issn.1008-0074. 2020.03.04.
[2] 秦海霞,张铃羚,覃勤.延续护理在脑卒中吞咽障碍患者中的应用进展[J].护士进修杂志,2021,36(24):2246-2250,2260. DOI:10.16821/j.cnki.hsjx.2021.24.009.
[3] 李霞,厉学敏,王陈军,等.专科护士主导的家庭赋权方案在老年脑卒中吞咽障碍患者中的应用[J].中华现代护理杂志,2021,27(36):4957-4963. DOI: 10.3760/cma.j.cn115682- 20210801- 03405.
[4] 孙伟燕,吴丽仙.个体化吞咽障碍分级护理对脑卒中患者的影响[J].护理与康复,2021,20(6):39-42. DOI:10.3969/j.issn.1671-9875.2021.06.010
[5] 陶菊,陈霞,尹丹丹,等.早期综合护理干预在缺血性脑卒中吞咽障碍患者中的应用效果[J].安徽医学,2019,40(6):690-693.
[6] 刘先松,董永书.针刺联合吞咽训练对脑卒中后吞咽障碍病人SSA评分,MNA评分及吸入性肺炎发生率的影响[J].中西医结合心脑血管病杂志,2021,19(12):2083-2086. DOI:10.12102/j.issn.1672-1349.2021.12.028.
[7] 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.中国脑血管疾病分类(2015)[J].中华神经科杂志,2017,50(3):168-171. DOI: 10.3760/cma.j.issn.1006- 7876.2017.03.003.
[8] 肖树芹,常红,武剑,等.中文版GUSS吞咽功能评估量表的信效度研究[J].中华现代护理杂志,2013,19(34): 4189-4191. DOI:10.3760/cma.j.issn.1674-2907.2013.34.001.
[9] 段泉泉,胜利.焦虑及抑郁自评量表的临床效度[J].中国心理卫生杂志,2012,26(9):676-679. DOI:10.3969/j.issn. 1000-6729.2012.09.007.
[10] 王赵杰.中文版抑郁应对自我效能感量表的信效度研究[J].中国实用护理杂志,2017,33(15):1016-1019. DOI:10.3760/cma.j.issn.1672-7088.2017.13.015.
[11] 李军涛,王伊龙,于进洪,等. 脑卒中专门化生存质量量表(SS-QOL)中译本在冀南地区效度的研究[J].脑与神经疾病杂志, 2007,15(3):177-179.
[12] 于蕾,施雁,王颖林,等. 酸刺激结合康复护理在脑卒中吞咽障碍患者中的临床价值[J]. 现代医学,2020,48(2):284-287. DOI:10.3969/j.issn.1671-7562.2020.02.030.
[13] 薛芬. 责任制护理对急性脑卒中后吞咽障碍患者预后的影响[J]. 国际护理学杂志,2021,40(21):3969-3972. DOI:10.3760/cma.j.cn221370-20200605-01118.
[14] 周南香,冯国琴,刘美华,等. 基于思维导图联合定量化预测模型对缺血性脑卒中合并吞咽障碍病人的护理实践[J]. 蚌埠医学院学报,2021,46(11):1634-1638. DOI:10.13898/j.cnki.issn.1000-2200.2021.11.034.
[15] 任震晴,石丹,蒋苏,等. 脑卒中后吞咽障碍康复管理流程构建与应用[J]. 护理学杂志,2020,35(15):11-14. DOI:10.3870/j.issn.1001-4152.2020.15.011.
[16] 王文,朱文欣,刘康永. 精密型摄食训练监管护理在脑卒中后吞咽障碍者中的应用研究[J]. 检验医学与临床,2021,18(18):2725-2728. DOI:10.3969/j.issn.1672-9455. 2021.18.026.
[17] 邓彬,陈艳,欧秀君,等. 吞咽训练对社区脑卒中吞咽障碍患者吞咽功能及康复预后的影响[J]. 河北医药,2020,42(14):2219-2222. DOI:10.3969/j.issn.1002-7386.2020.14.035.
[18] 王朝辉,唐娜,封彬. 急性脑卒中吞咽障碍患者早期康复护理的效果观察[J]. 中国中西医结合急救杂志,2020,27(6):709-712. DOI:10.3969/j.issn.1008-9691.2020.06.019.
[19] 王彦钊,韩洪燕,房铭,等. 吞咽功能障碍训练配合构音障碍训练对脑卒中后吞咽障碍的康复效果[J]. 国际医药卫生导报,2021,27(5):675-678. DOI:10.3760/cma.j.issn. 1007-1245.2021.05.011.
[20] 何子龙,崔芳,孙柳青,等. 神经肌肉电刺激联合吞咽康复训练对脑卒中后吞咽障碍患者吞咽功能、表面肌电图及舌骨喉复合体动度的影响[J]. 现代生物医学进展,2021,21(17):3368-3372. DOI:10.13241/j.cnki.pmb.2021. 17.036.
[21] 邓洪华,程岩,刘媛,等. 医养结合对脑卒中吞咽障碍患者的康复与护理效果观察[J]. 河北医药,2020,42(17):2692-2696. DOI:10.3969/j.issn.1002-7386.2020.17.033.
[22] 黄洁,陈晓锋,李思明,等. 舌肌康复器联合吞咽康复治疗脑卒中病人口腔期吞咽障碍的疗效观察[J]. 中西医结合心脑血管病杂志,2020,18(7):1158-1160. DOI:10.12102/j.issn.1672-1349.2020.07.033.
[23] 魏丹,李伟明. 分组康复训练对脑卒中吞咽障碍患者神经功能、吞咽功能和心理状态的影响[J]. 贵州医药,2019,43(4):639-640. DOI:10.3969/j.issn.1000-744X.2019.04.054.
[24] 陈秀恩,郑洁皎,朱婷,等. Stroop范式结合吞咽康复训练对老年脑卒中后假性球麻痹致吞咽障碍康复的影响[J]. 老年医学与保健,2020,26(3):359-361,366. DOI:10.3969/j.issn.1008-8296.2020.03.007.
[25] 刘爱华,白亚娟,张晓宇,等. 人性化护理对脑卒中后吞咽障碍患者康复的效果观察[J]. 中国实用神经疾病杂志,2019,22(12):1377-1381. DOI:10.12083/SYSJ.2019.12.194.
[26] Benjapornlert P, Kagaya H, Inamoto Y, et al. The effect of reclining position on swallowing function in stroke patients with dysphagia [J]. J Oral Rehabil, 2020, 47(9):1120-1128. DOI: 10.1111/joor.13037.
[27] 高嘉营. 眼针联合康复训练治疗脑卒中合并吞咽障碍的临床疗效观察[J]. 浙江中医药大学学报, 2020, 44(8):798-802. DOI:10.16466/j.issn1005-5509.2020.08.016.
[28] 黄素玲,唐冬娥,孙会会. 质控康复护理在急性脑卒中后吞咽障碍患者中的应用效果[J]. 中华现代护理杂志,2022,28(6):825-827. DOI:10.3760/cma.j.cn115682-2 0210723-03277.
[29] 王云,鹿宇林,徐芬,等. 头颈部控制及呼吸肌训练在早期脑卒中吞咽障碍患者中的康复效果分析[J]. 西北国防医学杂志,2020,41(2):120-124. DOI:10.16021/j.cnki.1007- 8622. 2020.02.012.
[30] 权程. 想象训练和肌电生物反馈治疗对脑卒中后吞咽障碍病人康复的影响[J]. 护理研究,2022,36(2):333-336. DOI:10.12102/j.issn.1009-6493.2022.02.028.
[31] 王修麒,程国珍,赵艺.多学科协作的综合护理干预在老年脑卒中吞咽障碍患者康复中的应用[J].国际护理学杂志,2021,40(22):4144-4148. DOI:10.3760/cma.j.cn221370- 20191230-01166.