延续护理在吞咽障碍留置胃管患者中的应用

Application of the continuing care in dysphagia patients with indwelling gastric tube

目的：探讨延续护理在吞咽障碍患者留置胃管鼻饲中的应用效果,以减少并发症和再入院率。方法选择应用胃管进行鼻饲饮食的出院患者60例,分为观察组和对照组,各30例。观察组由院外延续护理小组主动实施护理。对照组回归家庭,由院外延续护理小组被动实施护理。比较两组患者鼻饲2个月后的鼻饲并发症、患者满意度、再就诊率、主动咨询率、吞咽功能的康复等指标。结果观察期内,观察组腹胀/腹泻、鼻咽黏膜损伤、误吸、肺部感染发生分别为1,2,2,1例,对照组为6,9,8,7例,两组比较差异有统计学意义（χ2值分别为4.04,5.45,4.32,5.19；P＜0.05）。观察组急诊就诊率、再入院率、主动咨询率分别为0%,6.7%,50%,对照组为13.3%,26.7%,6.7%,两组比较差异有统计学意义（χ2值分别为4.28,4.32,13.87；P＜0.05）。两组延续护理后满意度比较,观察组优于对照组,差异有统计学意义（U =2.121,P＜0.05）。结论对吞咽障碍留置胃管患者实施院外延续护理提高了护理质量、患者满意度和主动咨询率,减少了患者再就诊率。

Objective To investigate the application of continuing care in the indwelling gastric tube feeding of patients with dysphagia in order to improve the patients′ satisfaction and reduce complication as well as the readmission rate. Methods A total of 60 discharged patients undergoing indwelling gastric tube feeding were selected as the study subjects. Out-of-hospital nursing team conducted active care in the observation group consisting of 30 patients while the control group with 30 patients went back home and received passive care from the out-of-hospital nursing team. Indexes of the two groups were collected including complications after two-month indwelling gastric tube feeding, patients′ satisfaction, re-attendance rate, active consultation rate and swallowing rehabilitation and so on. Results The observation period, the observation group abdominal distension / diarrhea, nasopharyngeal mucosa injury, aspiration, lung infection were 1, 2, 2 and 1 cases, control group 6, 9, 8 and 7 cases with significant difference between two groups （ χ2 = 4. 04,5. 45,4. 32,5. 19, respectively; P 〈 0. 05）. In the observation group, the rates of ED visits, readmission rate, active consultation rates were 0% , 6. 7% and 50% while these of the control group were 13. 3% ,26. 7% and 6. 7% . There was significant difference between two groups （χ2 = 4. 28,4. 32,13. 87, respectively; P 〈 0. 05）; the two group continuity nursing satisfaction, the observation group than in the control group （ U = 2. 121, P 〈 0. 05）. Conclusions The continuing nursing care outside the hospital can improve the caring quality for patients experiencing indwelling gastric tube feeding, patients′ satisfaction and active consultation rate, and reduce the re-attendance rate.