脑卒中后吞咽障碍护理的研究进展

Advances in nursing of dysphagia after stroke

吞咽障碍是脑卒中后的常见并发症,脑卒中吞咽障碍会导致误吸和吸入性肺炎,同时也会造成进食量减少、脱水、电解质紊乱及营养不良,增加脑卒中患者病死率、延长住院时间和增加医疗费用。研究表明,护士对脑卒中后吞咽障碍患者的早期识别和干预可有效改善患者预后。本文综述了脑卒中后吞咽障碍相关的护理措施:吞咽障碍筛查(包括时间、执行者和工具);床旁进食评估;营养状况评估;饮食指导(包括食物的选择、进食护理);口腔护理。目前没有公认的脑卒中后吞咽障碍筛查工具,可开发适合我国的信效度较好的工具。同时,可基于国际吞咽障碍食物标准行动委员会饮食框架探究不同吞咽功能患者适合的食物等级以及不同等级的食物制作方法。

Dysphagia is a common complication after stroke.Dysphagia can lead to aspiration and aspiration pneumonia,as well as reduced food intake,dehydration,electrolyte disturbance,and malnutrition,all of which increase the mortality,prolong hospital stay,and medical expenses of stroke patients.Studies have shown that early identification and intervention by nurses in patients with post-stroke dysphagia can effectively improve the prognosis of patients.This article reviews the nursing measures related to dysphagia after stroke:Screening for dysphagia including timing,performers,and tools;assessment of bedside feeding;nutritional status assessment;dietary instruction including food selection,feeding care;and oral care.Currently,there is no recognized screening tool for dysphagia after stroke.In the future,A tool with sound reliability and validity should be developed for Chinese patients.At the same time,food grades suitable for patients with different swallowing functions and food preparation methods for different grades can be explored based on IDDSI framework.