卒中后吞咽障碍临床决策支持系统的构建及应用评价

Construction and application evaluation of a clinical decision support system for dysphagia after stroke

目的 构建卒中后吞咽障碍临床决策支持系统,并评价其在卒中后吞咽障碍识别与防控管理中的应用效果。方法 将急性缺血性脑卒中患者按入院时间分组,2023年7-9月(系统应用前)收治的患者33例为对照组,2023年10-12月(系统应用后)收治的患者33例为观察组。对照组在常规护理基础上进行改良洼田饮水试验,根据筛查结果进行饮食指导、经口进食安全教育、动态评估吞咽功能。观察组采用卒中后吞咽障碍临床决策支持系统(基于计算机语言和数据库模型构建,包括预警筛查、智能评估、风险警示、决策分析、评价提醒五大模块)筛查和评估患者吞咽障碍情况,并根据评估结果实施护理干预。评价系统应用前后患者吞咽功能筛查率、筛查结果准确率,以及护士吞咽障碍管理知识和行为得分、临床护士应用体验感。结果 观察组吞咽功能筛查率显著高于对照组(P<0.05);系统应用后临床护士吞咽障碍管理知识和行为得分显著高于应用前(均P<0.05);临床护士对系统使用体验感总分为(99.40±4.81)分。结论 构建的卒中后吞咽障碍临床决策支持系统可辅助护士在线决策,规范护士吞咽障碍管理行为,提高卒中患者吞咽功能筛查率,有效实施吞咽障碍防控措施,改善卒中后吞咽障碍管理质量,保证患者安全。

Objective To construct a clinical decision support system for dysphagia after stroke,and to evaluate its application effect in the identification,prevention and control management of dysphagia after stroke.Methods Patients with acute ischemic stroke were randomly selected and divided into two groups chronologically,the 33 patients admitted from July to September 2023(before the system was applied)were taken as a control group,and the other 33 patients admitted from October to December 2023(after the system was applied)were regarded as an intervention group.On the basis of routine care,the control group experienced Modified Water Swallow Test,then they were given targeted dietary guidance,oral feeding safety education and dynamic evaluation of swallowing function for dysphagia according to the screening results.While in the intervention group,the clinical decision support system for dysphagia after stroke(built based on computer language and database model,including five modules:early warning screening,intelligent assessment,risk warning,decision analysis,evaluation and reminder)was used to screen and evaluate patients′dysphagia,then targeted nursing intervention was accordingly implemented.Before and after application of the system,the screening rate of patients′swallowing function,the accuracy of screening results,the scores of nurses′swallowing disorder management knowledge and behavior,and the application experience of clinical nurses were evaluated.Results The swallowing function screening rate in the intervention group were significantly higher than those in the control group,after application of the system,the scores of swallowing disorder management knowledge and behavior of clinical nurses were significantly higher than those before application of the system(all P<0.05).The total score of clinical nurses′application experience of the system was 99.40±4.81.Conclusion The constructed clinical decision support system for dysphagia after stroke can assist nurses to make online decisions,standardize the management behavior of dysphagia,enhance the screening rate of dysphagia in stroke patients,and effectively implement dysphagia prevention and control measures,then improve the quality of dysphagia management after stroke,and ensure the safety of patients.