吞咽障碍筛查与前瞻性干预对神经内科住院患者吸入性肺部感染的影响研究

Effects of dysphagia screening and prospective intervention on inhalation pulmonary infections in hospitalized neurology patients

目的探讨吞咽障碍筛查及前瞻性干预对神经内科住院患者吸入性肺部感染的影响。方法选取医院2014年1月-2016年5月住院的324例患者为研究对象,随机分为两组,各162例。对照组予以常规干预治疗,观察组予以吞咽障碍前瞻性干预,比较两组患者疗效。结果对照组吞咽障碍53例,检出率为32.72%,观察组吞咽障碍87例,检出率为53.70%,差异有统计学意义(P<0.05)。治疗4周后对照组吸入性肺部感染22例,感染率为13.58%,观察组吸入性肺部感染6例,感染率为3.70%,差异有统计学意义(P<0.05)。28例感染患者共检出病原菌52株,其中革兰阴性菌33株占63.46%,革兰阳性菌17株占32.69%;对照组疗效总有效率为66.04%,观察组总有效率为81.61%,差异有统计学意义(P<0.05)。治疗4周后对照组肺部感染患者白细胞计数、中性粒细胞百分比、氧合指数、胸片阴影缩小≥50%与观察组比较,差异有统计学意义(P<0.05)。结论吞咽障碍筛查能提高吞咽障碍检出率,结合吞咽障碍前瞻性干预能够降低吸入性肺部感染发生率,提高患者治疗效果。

OBJECTIVE To explore the influence of dysphagia screening and prospective intervention on inhalation pulmonary infections in hospitalized neurology patients.METHODS A total of 324 cases of patients from Jan.2014 to May 2016 in our hospital were selected as the research objects,and were randomly divided into two groups,with 162 cases in each group.Patients in control group were received conventional intervention,and in observation group were used dysphagia prospective intervention.The efficacy between the two groups were compared.RESULTS There were 53 cases of dysphagia in control group,with the detection rate of 32.72%,and 87 cases in observation group,with the detection rate of 53.700%,the difference was significant（P〈0.05）.After 4 weeks of treatment,22 cases had inhalation pulmonary infection in control group,with the infection rate of 13.58%,and6 cases in observation group,with the infection rate of 3.70%,which was significant（P〈0.05）.Totally 52 strains of pathogenic bacteria were detected in 28 cases,including 33 strains of gram-negative bacteria,accounting for 63.46%,and 17 strains of gram-positive bacteria,accounting for 32.69%.Compared with the clinical curative effect,the total effective rate of control group was 66.04%,and the total effective rate of observation group was81.60%,and the difference was significant（P〈0.05）.After 4 weeks of treatment,compared with observation group,the white blood cell count,neutrophil percentage,oxygenation index and reduction of chest X-ray shadow more than 50% of control group of patients had significant differences（P〈0.05）.CONCLUSION Dysphagia screening can improve the detection rate of dysphagia,and can reduce the incidence of inhalation pulmonary infections and improve the treatment effect combined with dysphagia prospective intervention.