多学科协作循证护理预防重症医学科经口气管插管患者拔管后吞咽障碍的效果研究  

Preventive effect of multidisciplinary collaborative evidence⁃based nursing on dysphagia in patients with orotracheal intubation in ICU after extubation

作　　者：朱早兰 王园治 李敏 沈慧俊 陈淑怡 彭文伟 Zhu Zaolan;Wang Yuanzhi;Li Min;Shen Huijun;Chen Shuyi;Peng Wenwei(Department of Critical Care Medicine,Dongguan Traditional Chinese Medicine Hospital,Dongguan 523000,China)

机构地区：[1]东莞市中医院重症医学科,广东东莞523000

出　　处：《海军医学杂志》2025年第4期387-391,共5页Journal of Navy Medicine

基　　金：广东省中医药局科研项目(20242104)。

摘　　要：目的探究多学科协作循证护理预防重症医学科(ICU)经口气管插管患者拔管后吞咽障碍的效果。方法回顾性分析2023年1—12月东莞市中医院收治的200例ICU经口气管插管患者的临床资料。将2023年1—5月入院的患者纳入常规组(96例)接受常规护理,将2023年6—12月入院的患者纳入循证组(104例)接受多学科协作循证护理。观察2组患者拔管后吞咽障碍的发生率、洼田饮水试验结果、吞咽功能[中文版安德森吞咽困难量表(MDADI)]、心理状态[中文版心理弹性量表(CD⁃RISC)]、生活质量[吞咽障碍特异性生活质量量表(SWAL⁃QOL)]、吞咽障碍并发症发生率(误吸、吸入性肺炎、营养不良)。结果循证组患者拔管后吞咽障碍发生率低于常规组(P<0.05),洼田饮水试验等级为Ⅰ级的患者多于常规组(P<0.05),MDADI量表总分、CD⁃RISC量表各维度评分均高于常规组(P<0.05),SWAL⁃QOL量表各维度评分及总分均低于常规组(P<0.05)。循证组吞咽障碍患者的并发症发生率低于常规组(P<0.05)。结论多学科协作循证护理可有效降低ICU经口气管插管患者拔管后吞咽障碍的发生率,改善患者预后的吞咽功能、心理状态和生活质量,降低吞咽障碍并发症发生率。Objective To explore the preventive effect of multidisciplinary collaborative evidence⁃based nursing on dysphagia in patients with orotracheal intubation in intensive care unit(ICU)after extubation.Methods A retrospective analysis was performed on 200 patients with orotracheal intubation in ICU who were admitted to Dongguan Traditional Chinese Medicine Hospital between January and December 2023.Of them,96 patients who were admitted to our hospital between January and May 2023 received routine nursing(routine group),104 patients who were admitted to our hospital between June and December 2023 received multidisciplinary collaborative evidence⁃based nursing(evidence⁃based group).The incidence of dysphagia after extubation,water swallowing test result,swallowing function measured with M.D.Anderson dysphagia inventory(MDADI),psychological state assessed by connor⁃davidson resilience scale(CD⁃RISC),quality of life assessed by swallowing quality⁃of⁃life questionnaire(SWAL⁃QOL),and the incidence of dysphagia complications(aspiration,aspiration pneumonia,and malnutrition)were compared between the two groups.Results The incidence of dysphagia after extubation and the water swallowing test class in the evidence⁃based group were lower than those in the routine group(both P<0.05).The total score of MDADI and CD⁃RISC scores in the evidence⁃based group were significantly higher than those in the routine group(P<0.05),while the SWAL⁃QOL scores were lower(P<0.05).The incidence of complications in the evidence⁃based group was significantly lower than that in the routine group(P<0.05).Conclusion Multidisciplinary collaborative evidence⁃based nursing can effectively reduce the incidence of dysphagia in patients with orotracheal intubation in ICU after extubation,improve swallowing function,psychological state and quality of life,and reduce the incidence of complications.

关 键 词：吞咽障碍 气管插管 重症医学科 多学科协作循证护理 

分 类 号：R473[医药卫生—护理学]