基于Iowa循证实践模式的管理方案对脑卒中患者吞咽功能的影响  

Effect of Iowa evidence practice mode-based management program on the swallowing function in stroke patients

作　　者：罗艳芳[1] 鲁桂英[1] 李姗姗[1] 张红英[1] 陈敏[1] 李琼华[1] Luo Yanfang;Lu Guiying;Li Shanshan;Zhang Hongying;Chen Min;Li Qionghua(Intensive Care Unit,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院重症医学科,南充637000

出　　处：《中国实用护理杂志》2020年第28期2165-2170,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨基于Iowa循证实践模式构建的脑卒中吞咽障碍管理方案对脑卒中患者吞咽功能的影响。方法选择2017年4月至2018年4月川北医学院附属医院收治的88例脑卒中吞咽障碍患者为研究对象,按照随机数字表法分为试验组和对照组各44例。对照组给予常规护理方案,试验组实施基于Iowa循证实践模式构建的脑卒中吞咽障碍管理方案。干预30 d后,采用洼田饮水试验评价患者吞咽功能,简明健康状况调查表(SF-36)评价患者生命质量,同时比较2组患者吸入性肺炎发生率。结果干预后试验组洼田饮水试验1级的患者增加至29.3%(12/41),对照组增加至18.6%(8/43),试验组洼田饮水试验评级明显优于对照组(Z值为2.332,P<0.05)。干预后试验组精力、社会功能、情感职能、精神健康等维度得分分别为(61.39±13.07)、(60.44±10.89)、(62.07±14.82)、(64.78±15.24)、(446.15±42.06)分,明显高于对照组的(53.19±14.77)、(50.09±13.15)、(53.91±16.72)、(57.81±16.34)、(410.98±35.81)分,差异有统计学意义(t值为2.018~4.133,P<0.01或0.05)。试验组吸入性肺炎发生率为2.4%(1/41),明显低于对照组的16.3%(7/43),差异有统计学意义(χ2值为4.666,P<0.05)。结论以Iowa循证实践模式为依据构建的脑卒中吞咽障碍管理方案,能有效改善患者吞咽功能、提高生命质量和降低吸入性肺炎发生率,具有一定临床推广价值。Objective To explore the effect of Iowa evidence practice mode-based management program on the swallowing function in stroke patients.Methods A total of 88 stroke patients in affiliated hospital of North Sichuan Medical College from April 2017 to April 2018 were recruited in the present study.Patients were randomly divided into experimental group(44 cases)and control group(44 cases)according to the random number table.The control group received routine nursing,while the Iowa evidence practice mode-based management program was carried our in the experimental group.After 30 days of intervention,the swallowing function was assessed by water swallow test,quality of life was evaluated by Short form of 36,the incidence of aspiration pneumonia was also compared between groups.Results After intervention,the grade 1 patients in water swallow test were up to 29.3%(12/41)in the experimental group,and 18.6%(8/43)in the control group,the water swallow test was better in the experimental group compared to the control group(Z value was 2.332,P<0.05).After intervention,the scores of vitality,social functioning,role-emotional,mental health were significantly increased in the experimental group compared to the control group(61.39±13.07,60.44±10.89,62.07±14.82,64.78±15.24,446.15±42.06 vs.53.19±14.77,50.09±13.15,53.91±16.72,57.81±16.34,410.98±35.81),the difference was statistically significant(t value was 2.018-4.133,P<0.01 or 0.05).The incidence of aspiration pneumonia was significantly decreased in the experimental group(2.4%,1/41)compared to the control group(16.3%,7/43),the difference was statistically significant(χ2 value was 4.666,P<0.05).Conclusions Iowa evidence practice mode-based management program can promote the swallowing function of stroke patients,as well as promote improve quality of life and decrease the incidence of aspiration pneumonia.It serves as an instruction for clinical intervention.

关 键 词：循证实践 脑卒中 吞咽障碍 吞咽功能 生活质量 

分 类 号：R473.74[医药卫生—护理学]