针对性评估与干预在吞咽困难患者中的应用

Clinical effect of targeted assessment and intervention in patients with dysphagia

目的探讨针对性评估与干预在急性脑卒中吞咽障碍患者疗效的作用。方法将101例吞咽障碍的急性脑卒中患者随机分为观察组51例和对照组50例。对照组采用常规的护理评估与干预方法，采用洼田饮水试验进行评估；观察组借鉴香港医院的吞水测试和吞糊测试进行评估。比较两组患者吞咽障碍疗效、吸入性肺炎发生率、留置胃管的病例数、平均拔管时间。结果经护理干预后，观察组吞咽障碍疗效优于对照组（Z=4．433，P〈0．01），住院期间吸入性肺炎的发生率和留置胃管的例数少于对照组（x2=5．156，P〈0．05），平均拔管时间较对照组明显缩短（t=56．877，P〈0．01），差异均有统计学意义。结论针对性评估与干预比传统的评价方法更优良。

Objective To explore the effect of targeted assessment and intervention in acute stroke patients with dysphagia. Methods 101 cases of patients were randomly divided into two groups, the experimental group （n =51 ） and the control group （n = 50）. The control group was given conventional nursing. The experimental group was given improved swallowing test procedure, including assessment of swallowing function, water swallowing test and puree test. Therapy effect, occurrence of aspiration pneumonia and cases of gastric tube requirement were compared between the two groups. Results Compared with the control group, the swallowing capability of experimental group was improved（ Z = 4. 433, P 〈 0. 01 ）, and occurrence of aspiration pneumonia（ x2 =5. 156 ,P 〈0. 05 ）, cases of gastric tube requirement and duration of gastric tube retention was lowered （t = 56. 877, P 〈 0. 01 ）. The differences were statistically significant. Conclusions Targeted assessment and intervention in acute stroke patients is superior to the conventional method.