不同护理方法对脑卒中昏迷患者吞咽功能影响的比较

Effect comparison of different nursing methods on swallowing function of patients with stroke coma

目的：比较口咽部辣椒汁与冷刺激对脑卒中昏迷伴气管切开患者吞咽功能的影响效果。方法将93例脑卒中昏迷患者随机分为三组，对照组（n ＝30）给予常规口腔护理加舌咽部按摩；冷刺激组（n ＝32）给予常规口腔护理加冷刺激；辣椒汁刺激组（n ＝31）给予常规口腔护理加辣椒汁刺激。比较三组患者口腔护理前后吞咽动作、气管切开时间、卒中相关性肺炎（SAP）发生率。结果口腔护理后10 min，对照组患者吞咽次数（21．09±9．16）次、冷刺激组（34．16±20．43）次、辣椒汁组（49．31±25．17）次，三组比较差异有统计学意义（F ＝12．962，P ＜0．05）。对照组患者气管置管（37．60±13．42）d、冷刺激组（29．19±8．24）d、辣椒汁组（22．04±8．23）d，三组比较差异有统计学意义（F ＝12．639，P ＜0．05）。三组患者 SAP 发生率分别为43．33％，37．50％，35．48％，差异无统计学意义（χ2＝0．616，P ＞0．05）。结论冷刺激与辣椒汁刺激都能有效刺激急性脑卒中昏迷气管切开患者的吞咽动作；辣椒汁刺激能长时间持续的刺激患者吞咽动作，有利于吞咽功能的恢复，且缩短气管切开患者置管时间，减少住院天数，值得在临床广泛推广。

Objective To explore the effect of pharyngeal chili sauce and cold stimulation on swallowing function of patients with stroke coma.Methods A total of 93 patients with stroke coma were included and randomly divided into three groups.The oral nursing and glossopharyngeal massage were performed in control group （n =30）.The oral nursing and cold stimulation were performed in cold stimulation group （n =32）.The oral nursing and chili sauce stimulation were performed in chili sauce stimulation group （n =31）.The swallowing movement,duration of tracheotomy and incidence of stroke-associated pneumonia were compared among three groups.Results Ten minutes after oral nursing,the swallowing frequency in control group,cold stimulation group and chili sauce stimulation group was （21.09 ±9.16）,（34.16 ±20.43）and （49.31 ±25.17）, respectively.The difference was statistically significant （F =12.962,P 〈0.05）.The duration of tracheotomy in control group,cold stimulation group and chili sauce stimulation group was （37.60 ±13.42）d,（29.19 ±8.24）d and （22.04 ±8.23）d,respectively.The difference was statistically significant （F =12.639,P 〈0.05）.The incidence of stroke-associated pneumonia in three groups was 43.33%,37.50% and 35.48%,respectively. there was no significant difference among three groups （χ2 =0.616,P 〉0.05）.Conclusions Both pharyngeal chili sauce and cold stimulation can improve swallowing function of patients with stroke coma.The pharyngeal chili sauce stimulation can stimulate swallowing movement for a longer time to help the recovery of swallowing function,and can shorten the duration of tracheotomy.