基于吞咽障碍筛查的个体化营养干预在桥小脑角区占位术后患者中的应用

Application of individualized nutritional intervention based on screening of dysphagia in postoperative patients with cerebellopontine angle occupying lesion

目的探讨基于吞咽障碍筛查的个体化营养干预模式在桥小脑角区占位术后患者中的应用效果。方法通过开展护士培训、选择专用的筛查与评估工具,制订筛查方法和个体化的营养干预措施与餐谱,制作筛查与干预流程图,并于2017年7月开始在桥小脑角区占位术后患者中实施。回顾实施前1年的桥小脑区占位术后患者46例为对照组,给予常规治疗和护理;实施后1年的48例患者为试验组,给予基于吞咽障碍筛查的个体化营养护理。结果试验组患者显性误吸发生率0、肺炎发生率4.17%(2/48)和腹泻的发生率2.08%(1/48)均低于对照组的4.35%(2/46)、21.74%(10/46)、19.57%(9/46),其中肺炎和腹泻发生率差异有统计学意义(χ^2=0.010、0.006,P<0.05或0.01);胃管留置率试验组31.30%(18/48)低于对照组的58.70%(27/46),差异有统计学意义(χ^2=7.158,P=0.007);胃管留置时间试验组(4.47±1.13)d少于对照组的(5.11±0.70)d,差异有统计学意义(t=2.296,P=0.027);住院天数试验组(8.69±1.36)d少于对照组的(12.57±2.95)d,差异有统计学意义(t=8.248,P=0.000);术后7 d试验组营养状况优于对照组,差异均有统计学意义(t=4.888、5.188、4.039,P<0.01);工作开展后全科护士吞咽知识与技能明显提高,尤其是洼田饮水试验筛查的准确性由5/8提高至20/20,差异有统计学意义(χ^2=8.148,P=0.017)。结论对桥小脑角区占位术后患者实施基于吞咽障碍筛查的个体化的营养干预,能改善患者的临床结局,提高护士的综合能力,达到了护-患双赢的目的。

Objective To explore the effect of individualized nutrition intervention mode based on dysphagia screening in postoperative patients with cerebellopontine angle occupying lesion.Methods By developing nurses training,selecting special screening and evaluation tools,developing screening methods and individualized nutrition intervention measures and meal spectrum,making screening and intervention flow chart,and starting to be implemented in postoperative patients with cerebellopontine angle occupying lesion in July 2017.Forty-six patients with cerebellopontine angle occupying lesion in the previous year were reviewed as the control group,who were given routine treatment and nursing;One year after implementation,Another 48 patients were set as the experimental group,and were given individualized nutritional care based on screening of dysphagia.Results The incidence rate of dominant aspiration(0),pneumonia(4.17%,2/48)and diarrhea(2.08%,1/48)in the experimental group was lower than 4.35%(2/46),21.74%(10/46),19.57%(9/46)in the control group,especially the difference of incidence rate of pneumonia and diarrhea was statistically significant(pneumonia:χ^2=0.010,P=0.013;diarrhea:χ^2=0.006,P=0.007).The retention rate of gastric tube in the experimental group(31.30%,18/48)was lower than that in the control group(58.70%,27/46),the difference was statistically significant(χ^2=7.158,P=0.007).Average retention time of gastric tube in the experimental group(4.47±1.13)d was less than that in the control group(5.11±0.70)d,the difference was statistically significant(t=2.296,P=0,027).The hospitalization time in the experimental group(8.69±1.36)d were less than those in the control group(12.57±2.95)d,the difference was statistically significant(t=8.248,P=0,000).The nutritional status of 7 days after operation of the experimental group was better than that of the control group,the differenc e was statistically significant(albumin:t=4.888,P<0.01;prealbumin:t=5.188,P<0.01;hemoglobin:t=4.039,P<0.01).The knowledge and skills of swallowing of general nurses improved significantly after the work,in particular,the accuracy of screening tests for Wa Tian drinking water increased from 5/8 to 20/20.The difference was statistically significant(χ^2=8.148,P=0.017).Conclusions Individualized nutrition intervention based on screening for dysphagia can improve the clinical outcome of patients,improve the comprehensive ability of nurses and achieve a win-win situation of nurse-patient.