脑梗死吞咽功能障碍患者经口进食安全及交叉式学科性营养管理评价

Evaluation of oral eating safety and cross-disciplinary nutrition management in patients with cerebral infarction and swallowing dysfunction

目的探讨和评价脑梗死吞咽功能障碍患者经口进食安全及交叉式学科性营养管理干预效果。方法选取2018年01月~2020年02月间我院神经内科收治的存在严重吞咽功能障碍脑梗死患者64例,随机均分为对照组和观察组各32例。对照组予脑梗死吞咽障碍常规护理干预,观察组在常规护理基础上增加早期行IOE技术、经口进食安全管理及交叉式学科性营养管理干预措施。干预2周,对比两组吞咽功能、每餐平均进食时间、进食呛咳、拒绝进食行为发生情况及干预周期内吸入性肺炎发生率。结果干预后,观察组吞咽功能得分(1.06±0.38)分、每餐平均进食时间(17.25±1.83)min、进食过程中刺激性呛咳6.25%(2/32)、拒绝进食发生率6.25%(2/32),干预周期内吸入性肺炎发生率9.38%(3/32);对照组吞咽功能得分(2.66±0.26)分、每餐平均进食时间(28.38±2.12)min、进食过程中刺激性呛咳25%(8/32)、拒绝进食发生率28.13%(9/32),干预周期内吸入性肺炎发生率31.25%(10/32);两组各统计数据间差异有统计学意义(P<0.05)。结论对存在严重吞咽障碍的脑梗死患者早期行IOE技术、经口进食安全管理及交叉式学科性营养管理,可明显缩短患者每餐平均进食时间,减少进食过程中刺激性呛咳的发生,减少拒绝进食行为,提高吞咽功能,降低因误吸导致的吸入性肺炎发生率。

Objective To explore and evaluate the safety of oral eating and the effect of interdisciplinary nutrition management intervention in patients with cerebral infarction and swallowing dysfunction.Methods A total of 64 patients with severe swallowing dysfunction and cerebral infarction who were admitted to the Department of Neurology in our hospital from January 2018 to February 2020 were selected and randomly divided into control group and observation group with 32 cases each.The control group received routine nursing intervention for dysphagia due to cerebral infarction,and the observation group added early IOE technology,oral eating safety management and cross-disciplinary nutrition management intervention measures on the basis of routine nursing.After 2 weeks of intervention,the swallowing function,average meal time per meal,coughing,refusal to eat and the incidence of aspiration pneumonia during the intervention period were compared between the two groups.Results After the intervention,the observation group’s swallowing function score was(1.06±0.38),the average eating time per meal was(17.25±1.83)min,the irritating coughing during eating was 6.25%(2/32),and the incidence of refusal to eat was 6.25%(2/32),the incidence of aspiration pneumonia during the intervention period was 9.38%(3/32);the score of swallowing function in the control group was(2.66±0.26),the average eating time per meal(28.38±2.12)min,irritating choking during eating Cough was 25%(8/32),the incidence of refusal to eat was 28.13%(9/32),and the incidence of aspiration pneumonia during the intervention period was 31.25%(10/32);the difference between the two groups of statistical data was statistically significant(P<0.05).Conclusion Early implementation of IOE technology,oral eating safety management,and interdisciplinary nutrition management for patients with severe dysphagia and cerebral infarction can significantly shorten the average meal time of patients,reduce the occurrence of irritating coughing during eating,and reduce Refusing to eat,improve swallowing function,and reduce the incidence of aspiration pneumonia caused by aspiration.