艾灸联合康复护理干预防治脑中风并发吞咽功能障碍随机平行对照研究

Moxibustion combined with Rehabilitation Nursing Intervention on Prevention of Stroke Complicated with Swallowing Dysfunction of Randomized Parallel Study

[目的]观察艾灸联合康复护理干预防治脑中风并发吞咽功能障碍疗效。[方法]使用随机平行对照方法,将60例住院患者按病志号抽签方法简单随机分为两组。对照组30例基础护理:指导及全程监护患者进食,误吸立即吸出,加强咳嗽动作训练,提高排除气管异物能力;餐前后口腔护理;吞咽训练:(1)空吞咽口水等;(2)手指捏紧下颚,做张口动作;多做张口、鼓腮、闭唇、吹气、闭眼、吸吮以及微笑等动作,让患者舌尖与舌体向口腔上部顶起用力舔舐上颚,并做伸舌卷舌等运功;(3)吞咽反射:长棉棒刺激腭弓、软腭、舌后部及咽后壁等。摄食训练:(1)半卧位或健侧卧位,食物便于集中健侧口腔;(2)由黏性半流食物→半固体食物→易咀嚼固体食物→流质,循序渐进,小量开始,逐步增加,进食速度宜慢不宜快。观察摄食情况、进食呛咳、进食时间,指导患者正确处理滞留在咽部食物,包括空吞咽、交互吞咽、侧方吞咽,去除滞留咽部食物残渣等。心理护理:与患者交流沟通,疏导疾病恐惧心理。治疗组30例艾灸:平躺或半卧位,颈部暴露,天突、廉泉温和灸或回旋灸,15~20min/穴,以皮肤红晕为度,同时双侧颈部按摩,10~15min/次,2次/d;基础护理同对照组。连续康复护理干预2周为1疗程。观测临床症状、吞咽功能、不良反应。康复护理干预1疗程(1周),判定疗效。[结果]治疗组优8例,良13例,中5例,可3例,差1例,优良率70.00%,对照组优5例,良7例,中10例,可5例,差3例,优良率40.00%,治疗组优于对照组(P<0.05)。[结论]艾灸联合康复护理干预防治脑中风并发吞咽功能障碍,疗效满意,无严重不良反应,值得推广。

[Objective] To observe moxibustion combined with rehabilitation nursing intervention on stroke prevention with swallowing dysfunction. [Method] Using random parallel control method, 60 patients were randomly divided into two groups according to the method of sickness number drawing. The control group of 30 cases： basic nursing care for patients with eating guidance and full of aspiration, immediately sucked out, strengthen cough training, improve the ability to exclude tracheal foreign body before and after meal; oral care; swallowing training： air swallowing slobber; the fingers clenched jaw, mouth movements do; do mouth, gills drums, closed lips, blowing and sucking and smiling eyes, etc, and to make the tongue tongue in patients with oral top worked hard and tongue licking palate, tongue motion; the swallowing reflex： long swab stimulated palatal arch, soft palate, tongue back and posterior wall etc. Feeding training： semi supine or lateral position, food easy to focus on the contralateral oral cavity; the viscous flow of food, semi semi-solid food, easy to chew solid food, liquid, step by step, start small, gradually increase the speed of eating slow not fast. Observation on feeding, cough when eating, eating time, guide patients to correctly handle the retention in the pharynx of food, including air swallowing, swallowing, swallowing lateral interaction, the removal of residual pharyngeal residue of food etc. Psychological care： communication with patients to ease the psychological fear of disease. The treatment group of 30 cases of moxibustion： flat or semi supine, neck exposed, sudden,Lian Quan moxibustion or cyclotron moxibustion, 15-20 min/points to the skin blush, and bilateral neck massage, 10-15 min/times, 2 times/d; basic mlrsing w-ith the control group. Continuous rehabilitation nursing intervention for 2 weeks for the course of treatment of 1. Clinical symptoms, swallowing function and adverse reactions were observed. Rehabilitation nursing intervention 1 course （for 1 weeks）, determine curative effect. [Results] The treatment group g eases were excellent, good in 13 cases, in 5 eases, 3 eases, poor in 1 eases, the exeellent rate was 70%, 5 cases of the control group, 7 eases were good, 10 cases, 5 cases, poor in 3 eases, the excellent rate was 40%, the treatment group than the control group （P〈0.05）. [Conclusion] The curative effect of moxibustion combined with rehabilitation nursing intervention on stroke prevention with swallowing dysfunction, with no serious adverse reactions, worthy of promotion.