“ASK-T”防误吸管理模式在降低老年慢性阻塞性肺疾病合并吞咽障碍患者误吸风险中的应用  

Application of the"ASK⁃T"aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease(COPD)complicated by dysphagia

作　　者：何文芳[1] 周逊[1] 丁美祝[1] 陈艺萍[1] 刘倩丽 谈馨媛[1] HE Wenfang;ZHOU Xun;DING Meizhu;CHEN Yiping;LIU Qianli;TAN Xinyuan(Department of Pulmonary and Critical Care Medicine,Guangdong Provincial Hospital of Chinese Medicine,Higher Education Mega Center Hospital,Guangzhou 510006,Guangdong,China)

机构地区：[1]广东省中医院大学城医院呼吸与危重症医学科(PCCM),广东广州510006

出　　处：《实用医学杂志》2025年第3期434-441,共8页The Journal of Practical Medicine

基　　金：广东省医学科研基金项目(编号:C2023078);广州市基础研究计划(编号:2023A03J0226)。

摘　　要：目的探讨“ASK-T”防误吸管理模式在降低老年慢性阻塞性肺疾病(COPD)合并吞咽障碍患者误吸风险中的应用效果。方法选取2021年7月至2024年6月广东省中医院大学城医院呼吸病科收治的409例COPD患者中合并误吸风险的196例患者作为本次研究对象,其中将2021年7月至2022年12月期间收治的102例COPD合并误吸风险的患者设为改善前组,该组患者在住院期间接受科室原有的护理流程和管理模式,将2023年1月至2024年6月期间收治的94例COPD合并误吸风险的患者设为改善后组,该组患者则在科室引入实施创新改善项目:“ASK-T”防误吸管理模式后接受护理管理,2组患者均观察、随访4周,比较2组误吸风险等级、标准吞咽功能评价量表(SSA)评分、吞咽障碍指数量表(DHI)评分情况、误吸与吸入性肺炎发生情况、患者的营养状态以及对干预后的满意度情况。结果对比得出,实施改善措施后,改善后组患者的误吸风险等级明显低于改善前组(P<0.05),2组患者SSA评分、DHI各维度评分及DHI总评分较干预前均明显降低(P<0.05),且改善后组患者SSA评分、DHI各维度评分及DHI总评分较改善前组更低(P<0.05);随访4周结果显示,2组患者营养风险筛查NRS-2002评分均低于干预前(P<0.05),其中改善后组患者营养风险筛查NRS-2002评分明显较改善前组更低(P<0.05);对比显示,改善后组患者误吸及吸入性肺炎的发生率低于改善前组(P<0.05),患者对误吸相关预防措施的满意度评分较改善前组更高(P<0.05)。结论“ASK-T”防误吸管理模式在老年COPD合并吞咽障碍患者的护理中,能显著降低误吸风险及吸入性肺炎的发生率,有效改善患者的吞咽功能和生活质量,同时提升患者的营养状态。此外,该模式还显著提高了患者对干预措施的满意度,为老年COPD合并吞咽障碍患者的临床护理提供了科学、有效的管理策略,值得在临床中推广应用。Objective To explore the application effect of the"ASK-T"aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease(COPD)complicated by dysphagia.Methods 196 of 409 COPD patients with aspiration risk admitted to the Respiratory Disease Department of Guangdong Provincial Hospital of Chinese Medicine,Higher Education Mega Center Hospital from July 2021 to June 2024 were selected as the study object,and 102 COPD patients with aspiration risk admitted from July 2021 to December 2022 were set as the pre-improvement group.The patients in this group received the original nursing process and management mode of the department during hospitalization.94 COPD patients with aspiration risk admitted from January 2023 to June 2024 were set as the improved group,and the patients in this group were introduced into the department and implemented an innovative improvement project:"ASK-T"antiaspiration management mode and then received nursing management.Patients in both groups were observed and followed up for 4 weeks.The risk grade of aspiration,SSA score,DHI score,aspiration pneumonia and aspiration pneumonia,nutritional status and satisfaction after intervention were compared between the two groups.Result The comparison showed that after the implementation of improvement measures,the aspiration risk grade of patients in the improved group was significantly lower than that in the pre-improvement group(P<0.05),and the SSA score,DHI score and total DHI score of patients in the 2 groups were significantly lower than that before intervention(P<0.05).The SSA score,DHI score and DHI total score in the improved group were lower than those in the pre-improved group(P<0.05).The results of 4-week follow-up showed that the scores of NRS-2002 for nutritional risk screening in 2 groups were lower than before intervention(P<0.05),and the scores of NRS-2002 for nutritional risk screening in the improved group were significantly lower than those in the pre-improvement

关 键 词：“ASK-T”防误吸管理模式 慢性阻塞性肺疾病 老年患者 吞咽障碍 误吸风险 

分 类 号：R563.3[医药卫生—呼吸系统]