吞咽-摄食管理预防脑卒中吞咽障碍患者相关性肺炎的研究  

Swallow-feeding management of stroke patients with dysphagia to prevent pneumonia:a clinical research

作　　者：朱美红[1] 时美芳[1] 万里红[2] 金妹[1] 曾明[1] 顾旭东[1] 金敏敏[1] 王佳玲[1] 

机构地区：[1]嘉兴市第二医院康复医学中心,浙江省嘉兴市314000 [2]嘉兴市第二医院神经内科,浙江省嘉兴市314000

出　　处：《中华护理杂志》2016年第3期294-298,共5页Chinese Journal of Nursing

基　　金：2014年省卫生适宜技术成果转化计划(2014ZHA013)

摘　　要：目的 探讨吞咽-摄食管理在预防脑卒中吞咽障碍患者相关性肺炎中的应用效果。方法 对急性脑卒中患者,采用临床吞咽功能评估确定吞咽障碍及严重分级;对不同程度的吞咽障碍患者80例,随机分为实验组40例、对照组40例。实验组：在常规方法的基础上进行吞咽-摄食管理;对照组：根据病情采用神经营养、改善脑循环药物及其他药物对症支持治疗,同时针对肢体功能障碍给予运动疗法、作业疗法、物理因子治疗,肌电生物反馈治疗等常规方法,2~5h/d,6d/周。分别在治疗前、治疗后30d记录两组患者吸入性肺炎发生的情况及进行吞咽功能疗效评定。结果 治疗后两组吞咽功能均较治疗前明显好转,且实验组与对照组相比改善更明显,两组比较差异有统计学意义（P〈0.01）。实验组、对照组吞咽障碍改善总有效率分别为92.5%和62.5%,两组比较差异有统计学意义（P〈0.01）;实验组与对照组相比肺部感染情况明显偏低（10%与22.5%,P〈0.05）。结论 急性脑卒中后发生吞咽障碍患者在肌电生物反馈治疗的基础上进行吞咽-摄食训练管理,能明显提高患者的吞咽功能,降低脑卒中后相关性肺炎的发生。Objective To explore the effects of swallow-feeding management on aspiration pneumonia in patients with swallowing disorders after stroke. Methods The swallowing function of acute stroke patients was evaluated. Eighty patients with different degrees of dysphagia were randomly divided into the intervention group（n=40） and the control group（n=40）. The control group was given neurotropie ,cerebral circulation improving medicine and other medicine to support treatment,and were given physical therapy,occupational therapy and electromyographic biofeed- back therapy（EMGBFF）,6 days per week,2 to 5 hours per day;the intervention group was added with swallow-feed- ing management on the basis of routine in the control group. Patients in two groups were observed after 30 days and the incidence of aspiration pneumonia and swallowing function were recoded. Results The swallowing function in two groups improved after intervention,and improvement in the intervention group was much more significant than that in the control group （P〈0.01）; the overall efficiency rate in the control group and the intervention group was 62.5% and 92.5% with significant difference（P〈0.01）; the incidence of aspiration pneumonia was 10% in the intervention group and 22.5% in the control group. Conclusion The swallow-feeding management combined with EMGBFF can improve swallowing function in patients with acute stroke and reduce the incidence of pneumonia.

关 键 词：卒中 吞咽障碍 进食 误吸 肺炎 康复护理 

分 类 号：R473.74[医药卫生—护理学]