基于多学科小组管理的饮食干预对高龄吞咽障碍患者吸入性肺炎的影响

Effects of diet interventions on aspiration pneumonia in elderly patients with dysphagia based on multi-disciplinary management

目的：探讨进食安全指导及饮食干预对高龄吞咽障碍患者吸入性肺炎的影响。方法组建多学科团队小组,小组成员由临床医师、营养医师、康复师、护士组成。对符合入选标准的长期住院经口进食的高龄吞咽障碍患者,进行吞咽功能评估和进食安全指导。根据自愿原则和配对原则,分为观察组和对照组,每组各20例,对照组根据吞咽状况,兼顾患者的口味、意愿,进食半固体软食、浓流质、部分糊状饮食等；观察组将所有食物和液体按专业的方法制成全糊状饮食,两组患者均自行经口进食或喂食。观察3个月时两组患者在进食过程中发生呛咳、拒食、每餐进食时间的情况,并采用回顾性查阅病历的方法收集干预前3个月两组患者吸入性肺炎发生人次数,记录干预3个月内吸入性肺炎发生人次数,进行比较。结果进食时观察组患者在进食过程中呛咳发生109例、拒食22例、每餐进食时间为（18.64±5.05）min,分别少于对照组的272例、135例、（25.78±8.37）min,差异有统计学意义（χ^2分别为7.369,4.433；t=-4.363；P〈0.05）；干预后两组吸入性肺炎发生人次均有下降,观察组为13∶4,对照组为11∶7,差异有统计学意义（χ^2分别为20.742,13.809；P〈0.05）；对照组有2例患者因出现明显呛咳和误吸,给予鼻饲后1例并发多脏器功能衰竭死亡；观察组无中途退出者。结论基于多学科密切合作的小组团队可提高高龄吞咽障碍患者的检出率,开展专业的进食安全管理和饮食干预可减少误吸和吸入性肺炎的发生,改善高龄患者的生存质量。

Objective To explore the effects of the diet safety instructions and interventions on aspiration pneumonia in elderly patients with dysphagia. Methods The multidisciplinary team was established involved clinical physicians, dietitians, therapists and nurses. The study investigated 40 elderly long-stay patients with dysphagia who were capable of oral feeding were selected according with the inclusive criteria. After the swallowing assessment and diet safety instructions, the participants were divided into intervention group （n=20） and control group （n=20） under the principle of voluntariness and matching selection. The patients of intervention groups were supplied with all mushy diet; the patients of control group had semi-solid, thick liquid, partial mushy diet, etc. depended on participants′ swallowing situations and tastes. Both groups of patients were oral feeding on their own or with help. The incidence of bucking, food refusal and feeding time per meal were investigated during the three months, and the aspiration pneumonia incidence of two groups were retrospectively analyzed three months before interventions. Results In the intervention group, the incidence of bucking （109）, food refusal （22） and feeding time per meal [（18. 64 ± 5. 05） min] were lower than those in the control group [bucking （272）;food refusal （135）; feeding time per meal （25. 78 ± 8. 37） min] （χ^2=7. 369, 4. 433;t= -4. 363;P〈0. 05）. After three months′interventions, the incidence of aspiration pneumonia in both groups was decreased that the intervention group was 13 ∶ 4 and the control group was 11 ∶ 7 （χ^2=20. 742,13. 809;P〈0. 05）. The control group had two cases with bucking aspiration and one cases with multiple organ failure and death after nasal feeding; the intervention group had no dropout. Conclusions A close cooperation of multi-discipline team can significantly improve the detection rate and feeding safety management of elderly patients with dysphagia. The diet intervention and safety eating management can reduce the incidence of aspiration pneumonia and promote the patients′quality of life.