分级护理在环状软骨上喉部分切除术后吞咽障碍患者中的应用

Nursing for Patients after Supracricoid Partial Laryngectomy based on the Grade of Dysphagia

目的探讨分级护理在喉癌行环状软骨上喉部分切除术(supracrieoid partial laryngectomy,SCPL)后吞咽障碍患者中的应用方法及效果。方法2017年1月至2019年1月,采取便利抽样法选取在南京某三级甲等医院耳鼻咽喉头颈外科行SCPL的90例喉癌患者为研究对象,按随机数字表法将其分为观察组和对照组各45例,对照组患者给予喉癌术后常规康复训练和进食指导;观察组患者利用才藤式吞咽障碍7级评估法评估患者的吞咽功能,根据评估等级制订康复训练计划和进食训练指导,同时使用分级护理监测单对患者进行分级护理。结果干预后,观察组患者刺激性呛咳、误咽的发生率及胃管留置时间、再插管率均低于或短于对照组患者(P<0.05或P<0.01)。结论分级护理的实施,可有效减少SCPL术后吞咽障碍患者的刺激性呛咳、误咽的发生,缩短胃管留置时间,降低胃管再插率,有利于促进患者吞咽功能的恢复。

Objective To explore the application and effect of nursing for patients after supracricoid partial laryngectomy(SCPL)based on the grade of dysphagia.Methods From January 2017 to January 2019,90 patients with laryngeal cancer who underwent SCPL in the otolaryngology head and neck surgery of a tertiary hospital in Nanjing were selected as the research objects by convenience sampling method.According to the random number table method,patients were divided into observation group and control group,with 45 cases in each group.The control group was given routine rehabilitation training and diet guidance after SCPL;the patients’swallowing function of the observation group was evaluated by 7 levels of Caiteng dysphagia,and the rehabilitation training plan and eating plan were made based on the dysphagia level.Results After the intervention,the incidence of irritating cough and dysphagia,the retention time of gastric tube and the rate of re-intubation in the observation group were shorter or lower than those in the control group(P<0.05 or P<0.01).Conclusions The implementation of graded nursing can effectively reduce the incidence of irritating cough and wrong swallowing in patients with dysphagia after SCPL,shorten the retention time of gastric tube,and reduce the re-insertion rate of gastric tube,so as to effectively help patients recover their swallowing function.