吞咽障碍筛查及前瞻性干预降低脑卒中患者吸入性肺炎发生率的研究

Study on the incidence of aspiration pneumonia in stroke patients with dysphagia screening and prospective intervention

目的探讨吞咽障碍筛查及前瞻性干预对降低脑卒中患者吸入性肺炎的作用。方法将186例急性脑卒中患者采用随机数字表法分为对照组和干预组各93例。对照组采用洼田饮水试验检测患者吞咽功能，并予以脑卒中常规护理；干预组采用洼田饮水试验联合监测脉冲氧饱和度筛查吞咽障碍，并在脑卒中常规护理的基础上应用前瞻性的干预。比较两组对吞咽障碍的检出率及对患者4周内吸入性肺炎发生率。结果干预组吞咽障碍的检出率高于对照组（41．9％比19．4％，）（2=11．16，P〈0．01），4周内吸入性肺炎发生率低于对照组（4．3％比12．9％，X2=4．38，P〈0．05）。结论洼田饮水试验联合监测脉冲氧饱和度筛查吞咽障碍并应用前瞻性的干预能提高吞咽障碍的检出率，并降低脑卒中吸入性肺炎的发生率。

Objective To investigate the effect of dysphagia screening and prospective interventional nursing in reducing the aspiration pneumonia in stroke patients. Methods 186 patients with acute stroke were randomly divided into control group and interventional group ,93 cases in each group. The Watian drinking water test was used to screen dysphagia, and the routine nursing was used in the control group. The combined screening of Watian drinking water test and oxygen desaturation monitoring was used to screen dysphagia, and prospective intervention nursing in addition to the routine nursing was used in the interventional group. The detection rate of dysphagia and the incidence of aspiration pneumonia in 4 weeks were compared between the two groups. Results The detection rate of dysphagia in the intervention group was higher than that in the control group （41.9% vs 19.4%, X2 = 11.16, P 〈 0.01 ）, and the incidence of aspiration pneumonia was lower than that in the control group （12.9% vs 4.3% ,χ2 = 4.38 ,P 〈 0. 05 ）. Conclusion The detection rate of dysphagia can be improved by using the combined screening of Watian drinking water test and oxygen desaturation monitoring. The incidence of aspiration pneumonia can be reduced by using combined screening with additional prospective interventional nursing.