集束化管理在脑梗死急性期预防吸入性肺炎中的应用研究

Application of cluster nursing in prevention of aspiration pneumonia in patients with cerebral infarction

目的探讨集束化管理在脑梗死急性期预防吸入性肺炎中的作用。方法选取2014年1月至2017年1月收治的脑梗死急性期患者72例，按照随机数字表法分为2组，每组36例。对照组给予饮食护理、排痰护理，疾病相关知识宣教等常规护理。干预组应用吞咽功能训练、摄食管理、自制角度测量仪进行体位管理等方法进行集束化管理。观察2组患者吸入性肺炎发生率、吞咽功能改善情况及患者满意度。结果干预组吸入性肺炎发生率5．56％（2／36），低于对照组的25．00％（9／36），差异有统计学意义（χ^2=5．258，P=0．022）；治疗后干预组吞咽功能评级结果明显优于对照组，差异有统计学意义（χ^2=7．943，P=0．036）；干预组患者治疗后满意度达94．44％（34／36），高于对照组的63．89％（23／36），差异有统计学意义（χ^2=17．526，P=0．000）。结论集束化管理能有效降低脑梗死急性期患者吸入性肺炎的发生率，且有助于改善患者吞咽功能和护患关系，具有一定临床应用价值。

Objective To investigate the effect of cluster nursing in the prevention of aspiration pneumonia in patients with cerebral infarction. Methods A total of 72 patients with acute cerebral infarction from January 2014 to January 2014 were recruited and divided into 2 groups with 36 cases each by random digits table method. The patients in control group were given diet nursing, nursing of sputum ejection, education of disease related knowledge and another routine nursing methods. While cluster nursing such as the application of swallowing function training, feeding management, homemade angle measuring instrument for position management were conducted on the patients in intervention group. The difference of incidence of aspiration pneumonia, improvement of swallowing function, and patient satisfaction between two groups were compared. Resuhs The incidence of aspiration pneumonia was 5.56%（2/36） in intervention group and 25.00%（9/36） in control group, and the difference was statistically significant （χ^2=5.258, P=0.022）.The swallowing function ratings after treatment in intervention group was also obviously better than that in control group, and the difference was statistically significant （χ^2=7.943, P=0.036）. The patient satisfaction was 94.44% （34/36） in intervention group and 63.89% （23/36） in control group, and the difference was statistically significant （χ^2=17.526, P=0.000）. Conclusions Cluster nursing can effectively reduce the risk of aspiration pneumonia in acute cerebral infarction patients, and help to improve the patients＂ swallowing function and relationship between nurses and patients, has certain clinical application value.