医养结合对脑卒中吞咽障碍患者的康复与护理效果观察

The nursing effects of integrated treatment and convalesce mode on patients with dysphagia due to cerebral stroke

目的探索实施医养结合下,康复治疗对脑卒中吞咽障碍患者功能恢复的影响。方法选取2017年1月到2019年8月收治的154例医养结合下的脑卒中吞咽障碍患者,依据患者的主观意愿分成2组,对照组78例给予常规日常照护及原发病的口服药物治疗,观察组76例在此基础上通过行为疗法、导管球囊扩张术给予康复治疗。康复治疗4周、8周后进行吞咽障碍的评估。观察对2组患者的影响。采用洼田饮水试验筛查吞咽功能;采用临床常用的营养风险筛查(nutritional risk screening,NRS)-2002量表进行营养的评估,预测营养不良的风险。结果康复治疗后4周、8周,观察组较对照组疗效显著(P<0.05),观察组治疗8周疗效较治疗4周疗效更显著(P<0.05)。对照组治疗8周较4周的疗效稍好,但差异无统计学意义(P>0.05)。患者康复治疗前、治疗后4周、8周,洼田饮水试验比较,2组患者治疗前的洼田饮水试验评分差异无统计学意义(P>0.05);治疗后2组患者洼田饮水试验评分,观察组明显低于对照组(P<0.05),观察组比较,康复治疗8周天较治疗4周,洼田饮水试验评分更低(P<0.05)。对照组在治疗4周、8周,洼田饮水试验评分变化不显著(P>0.05)。对2组吞咽障碍患者治疗4周、8周应用NRS-2002进行营养的评估进行比较,观察组较对照组营养不良风险显著降低(P<0.05),观察组治疗8周疗效较治疗4周营养不良风险降低更显著(P<0.05)。对照组8周较4周的营养不良风险有降低趋势,但变化不显著(P>0.05)。观察组较对照组吸入性肺炎发生例数明显减少.误吸率明显降低(P<0.05);观察组治疗8周疗效较治疗4周发生吸入性肺炎病例明显减少,误吸性肺炎率明显降低(P<0.05),对照组治疗8周较治疗4周发生吸入性肺炎病例数、误吸性肺炎发生率略有降低(P>0.05)。结论医养结合模式下的脑卒中吞咽障碍患者实施康复治疗,能有效提高康复好转率;改善吞咽障碍;降低了营养不良风险的发生,从而提高了患者的生存质量。

Objective To investigate the effects of rehabilitation therapy on functional recovery of stroke patients with dysphagia based on integrated treatment and convalesce mode.Methods A total of 154 on patients with dysphagia due to cerebral stroke who were treated by integrated treatment and convalesce mode in our hospital from January 2017 to August 2019 were enrolled in the study,who were divided into control group(n=78)and observation group(n=76)according to patient’s subjective willings.The patients in control group were treated by routine daily care and oral medication for primary disease including antihypertensive drugs,hypoglycemic drugs,lipid-lowering drugs,and drugs for the prevention of arteriosclerotic thrombosis,however,the patients in observation group,on the basis of control group,were given rehabilitation treatment,including behavioral therapy,oral exercise training,airway protection,respiratory function training,electromyographic biofeedback training,and balloon catheter dilatation.After 4-week and 8-week treatment,the changes of dysphagia were observed and compared between the two groups.Moreover the swallowing function was evaluated by using Water swallow test,and the nutritional risk screening(NRS)2002rating scales was used to assess the nutrition status of patients and to predict the risk of malnutrition.Results After 4-week and 8-week treatment,the therapeutic effects in observation group were superior to those in control group(P<0.05),and the therapeutic effects in observation group at 8 weeks were significantly better than those at 4 weeks(P<0.05).There were no significant differences in the scores by Water swallow test between the two groups(P>0.05).However the the risk of malnutrition in observation group was significantly lower than that in control group(P<0.05),moreover,which at 8 weeks in observation group was significantly lower than that at 4 weeks(P<0.05).However there was no significant difference in the risk of malnutrition in control group between 4 weeks and 8 weeks(P>0.05).In addition the incidence rate of aspiration pneumonitis in observation group was significantly lower than that in control group(P<0.05).Conclusion The rehabilitation treatment for stroke patients with dysphagia based on integrated treatment and convalesce mode can effectively improve the recovery rate,improve the swallowing disorder,significantly reduce the risk of malnutrition and effectively reduce the incidence of aspiration pneumonia,so as to improve the life quality of patients.