脑卒中后吞咽障碍患者实施预见性护理干预对吸入性肺炎的影响

Effect analysis of the predictive nursing intervention on the incidence of aspiration pneumonia in patients with post-stroke dysphagia

目的：探讨预见性护理干预对脑卒中后吞咽障碍患者发生吸入性肺炎的临床实效性。方法选择2013年1月—2014年10月接受治疗的吞咽障碍患者40例,并按照随机数字表法分为两组,观察组和对照组各20例。所有患者均接受同样治疗,对照组患者接受常规护理干预,观察组患者在对照组的基础上行预见性的护理干预。护理后1个月监测两组患者洼田饮水实验评分,吞咽功能分级评分以及临床疗效,并比较其吸入性肺炎发生情况及预后情况。结果观察组患者洼田饮水实验、吞咽功能分级评分明显高于对照组,差异具有统计学意义（t值分别为3.589,3.567；P〈0.05）；两组患者的总有效率分别为95%（19/20）和70%（14/20）,差异有统计学意义（χ^2 =4.621,P〈0.01）；观察组预后情况明显优于对照组,差异具有统计学意义（P〈0.05）；两组患者吸入性肺炎发生率分别为30%（6/20）和55%（11/20）,差异具有统计学意义（χ^2 =4.128,P〈0.05）。结论预见性护理干预对吞咽障碍患者具有很好的临床护理作用,能有效改善患者的吞咽功能,并减少吸入性肺炎的发生,值得在临床广泛推广。

Objective To research the effect of the predictive nursing intervention for the incidence of aspiration pneumonia in patients with post-stroke dysphagia （ PSD） . Methods A total of 40 patients with PSD in our hospital since January 2013 to October 2014 were selected, and were randomized divided into two groups, 20 cases in the observation group and 20 cases the control group. All patients received the same treatment, and the patients of control group were treated with conventional nursing intervention while the patients of observation group were treated with the predictive nursing intervention on the basis of the control group treatment. We supervised the Watian′s drinking water test （ WTDWT） score, swallowing function assessment （ SFA） score, clinical efficacy, and compared rate of aspiration pneumonia occurrence and the prognosis 1 month after the treatment in the two groups. Results The WTDWT score and SFA score were obviously higher than these in the control group, the difference was statistically significant （t=3. 589, 3. 567;P〈0. 05）;the total rate of clinical efficacy in the observation group and control group were respectively 95% （ 19/20 ） and 70% （ 14/20 ） , the difference was statistically significant （χ^2 =4. 621, P 〈0. 05 ）; the prognosis in the observation group were obviously better than this in the control group, the difference was statistically significant （P〈0. 05）;the rate of aspiration pneumonia occurrence in the observation group and control group were respectively 30% （6/20） and 55% （11/20）, the difference was statistically significant （χ^2 =4. 128,P〈0. 05）. Conclusions Predictive nursing intervention has a very good clinical nursing effect on the treatment for patients with PSD, can improve patients′swallowing function and effectively reduce the aspiration pneumonia occurrence, thus it is worth to be widely popularized in clinic.