基于吞咽功能筛查的分级护理干预在桥小脑角肿瘤患者中的运用研究

Application of graded nursing intervention based on swallowing function for patients with tumor of the cerebellum angle

目的探讨分级护理干预措施在桥小脑角肿瘤患者中的运用效果。方法将2014年8月-2015年9月人住我科的89例桥小脑角肿瘤患者按照人院顺序分为对照组和干预组，两组患者均通过洼田饮水试验来判断患者的吞咽功能。对照组在患者术后初次进食、进饮时进行吞咽功能测试，并根据测试结果进行常规护理。干预组对患者进行每日1次吞咽功能测试，并根据患者吞咽功能的分级来制订分级护理干预措施：包括患者进食前的体位；进食时的用具、一次量、饮食的种类、喂食的人员、吞咽技巧；进食后的口腔护理及功能锻炼等。比较两组患者在术后1～10d内吞咽可疑、障碍检出率、误吸发生率、胃管留置率上的差异。结果干预组在吞咽异常和障碍的检出率高于对照组（P〈0．05），误吸发生率和胃管留置率低于对照组（P〈0．05）。结论增加桥小脑角区肿瘤患者吞咽功能的筛查次数，可增加吞咽功能障碍的检出率。根据患者吞咽功能的动态变化，实施分级护理干预措施，规范护士护理行为，避免经验式护理，可保证患者的饮食安全，减少胃管置入，同时预防误吸的发生。

Objective To study the application effect of graded nursing intervention for patients with tumor of the cerebellar angle of the bridge. Methods 89 cases of patients hospitalized in our department from September 2015 to August 2014 were selected and divided into control group and intervention group. The patients in the two groups were tested by drinking water test to judge the swallowing function. The swallowing function test was performed in the control group during the first time after the operation, and routine nursing care was carried out according to the test results. The intervention group of patients was conducted swallowing function test once a day, according to the classification of swallowing function in patients to make grading nursing intervention measures： including patients before eating posture; types of eating utensils, quantity and type of die, feeding personnel and swallowing skills, oral care and functional exercise after eating after eating. The detection rate of suspicious swallowing obstacle, incidence of aspiration, the rate of indwelling gastric tube after 1 d- 10 d was were compared for the two group. Results The dysphagia and obstacle detection rate for intervention group was higher than that of the control group （P〈 0.05）, The aspiration incidence and rate of indwelling gastric tube for intervention group was lower than that of the control group （P 〈 0.05）. Conclusion The detection rate of swallowing dysfunction can be increased by increasing the number of swallowing function test for patients with tumor in the cerebellar angle of the bridge. According to the dynamic changes of swallowing function among patients, the implementation of grading nursing intervention meas ures, standardized nursing behavior and avoiding the experienced nursing can guarantee the food safety of the pa tients, reduce gastric tube insertion, and prevent the occurrence of aspiration.