Abstract:

Objective　To construct the sensitive early rehabilitation index of swallowing dysfunction in patients with acute stroke through evidence-based nursing intervention, and to observe the effect on swallowing function in patients with acute stroke. Methods　Seventy patients with acute stroke treated at Department of Neurology, Lianyungang Hospital of Traditional Chinese Medicine from January 2020 to October 2021 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 35 cases in each group. There were 23 men and 12 women in the control group; they were 57-77 (67.10±9.11) years old. There were 21 men and 14 women in the control group; they were 56-76 (66.76±8.74) years old. The control group were routinely cared. In the observation group, the sensitive early rehabilitation index of swallowing dysfunction in patients with acute stroke was constructed through evidence-based nursing intervention. The swallowing function before and 2 weeks after the nursing, swallowing times, and incidences of adverse events were compared between the two groups.χ² and t tests were used. Results　Two weeks after the intervention, the drinking water test scores were lower than those before the intervention in both group; the score in the observation group was lower than that in the control group [(2.12±0.46) vs. (2.46±0.45)], with a statistical difference (t=3.126; P<0.05). Two weeks after the intervention, the scores of the standard swallowing function rating scale (VFSS) and functional eating scale (FOIS) were higher than those before the intervention; the scores in the observation group were higher than those in the control group [(6.43±1.07) vs. (5.48±1.16) and (4.26±0.45) vs. (3.89±0.51)], with statistical differences (t=3.561 and 3.218; both P<0.05). Two weeks after the intervention, the body mass index (BMI) and levels of serum albumin (BSA) and hemoglobin (Hb) were higher than those before the intervention in both groups; the BMI and the levels of BSA and Hb in the observation group were higher than those in the control group [(22.12±2.61) kg/m² vs. (20.43±2.22) kg/m², (37.58±5.23) g/L vs. (35.35±4.23) g/L, (91.57±12.15) g/L vs. (85.42±12.32) g/L], with statistical differences (t=3.407, 2.592, and 2.731; all P<0.05). The incidence of adverse events in the observation group was lower than that in the control group [2.86% (1/35) vs. 22.86% (8/35)], with a statistical difference (χ²=6.248; P<0.05). Conclusion　Evidence-based nursing intervention for patients with acute stroke and construction of sensitive early rehabilitation index of swallowing dysfunction patients with acute stroke through evidence-based nursing intervention can improve their swallowing function and nutrition and reduce the occurrence of adverse events.

Key words:

Evidence-based concept, Nursing intervention, Acute stroke, Swallowing dysfunction, Sensitive index of early rehabilitation

摘要：

目的　通过循证理念为基础的护理干预对急性脑卒中患者吞咽功能障碍早期康复敏感指标进行构建，观察其在急性脑卒中患者吞咽功能中的影响。方法　选取连云港市中医院神经内科2020年1月至2021年10月收治70例急性脑卒中吞咽功能障碍患者为调查对象进行随机对照试验，随机数列法分为观察组与对照组，各35例。观察组男23例、女12例，年龄57～77（67.10±9.11）岁；对照组男21例、女14例，年龄56～76（66.76±8.74）岁。对照组采取常规护理干预，观察组以循证理念为基础重新构建急性脑卒中吞咽功能障碍早期康复敏感指标。比较两组护理前及护理2周后的吞咽功能、吞咽时间及不良事件发生情况。统计学方法采用χ²检验、t检验。结果　干预2周后，两组洼田饮水试验评分均低于干预前，且观察组低于对照组［（2.12±0.46）分比（2.46±0.45）分］，标准吞咽功能评定量表（VFSS）评分、功能性进食量表（FOIS）评分均高于干预前，且观察组均高于对照组［（6.43±1.07）分比（5.48±1.16）分、（4.26±0.45）分比（3.89±0.51）分］，差异均有统计学意义（t=3.126、3.561、3.218，均P<0.05）。干预2周后，两组体质量指数（BMI）、血清白蛋白（BSA）、血红蛋白（Hb）均高于干预前，且观察组均高于对照组［（22.12±2.61）kg/m²比（20.43±2.22）kg/m²、（37.58±5.23）g/L比（35.35±4.23）g/L、（91.57±12.15）g/L比（85.42±12.32）g/L］，差异均有统计学意义（t=3.407、2.592、2.731，均P<0.05）。观察组不良事件发生率为2.86%（1/35），低于对照组［22.86%（8/35）］，差异有统计学意义（χ²=6.248，P<0.05）。结论　采取以循证理念为基础的护理干预对急性脑卒中吞咽功能障碍早期康复敏感指标构建后能够提高患者吞咽功能与营养水平，降低不良事件的发生。

关键词:

循证理念, 护理干预, 急性脑卒中, 吞咽功能障碍, 早期康复敏感指标