护士主导的康复管理方案在脑卒中吞咽障碍相关性肺炎患者中的应用研究

doi:10.19983/j.issn.2096-8493.20230071

摘要/Abstract

摘要：

目的: 分析护士主导康复管理方案对脑卒中后吞咽障碍发生相关性肺炎患者的干预效果。 方法: 采用历史对照研究的方法选择在上海市第二康复医院呼吸重症康复科住院治疗的脑卒中后吞咽障碍发生相关性肺炎的患者,将2021年1月1日至2021年12月31日与2022年1月1日至2022年12月31日的患者分别设为对照组(87例)和观察组(79例)。对照组采用常规的脑卒中康复护理模式(包括神经康复护理常规、疾病宣教、康复和药物治疗、呼吸道护理等),观察组在常规护理模式的基础上给予护士主导的康复管理方案(包括肺部感染预后危险因素评估、建立康复管理方案、跟踪及评价管理效果等)。比较两组患者住院期间呼吸道并发症发生率、干预2周末肺炎好转率和干预4周末舒适度及日常生活活动能力(activities of daily living,ADL)变化。 结果: 观察组患者呼吸道并发症发生率为6.33%(5/79),明显低于对照组的20.69%(18/87),差异有统计学意义(χ²=6.827,P=0.009);观察组2周末肺炎好转率为92.24%(73/79),明显高于对照组的80.46%(70/87),差异有统计学意义(χ²=4.950,P=0.026);干预4周末观察组舒适度评分和日常生活活动能力评分分别为(57.25±8.54)分和(56.90±10.20)分,高于对照组的(48.29±7.34)分和(49.37±10.70)分,差异均有统计学意义(t=-4.675、-4.631,P值均<0.05)。 结论: 护士主导的康复管理方案能降低脑卒中后吞咽障碍发生相关性肺炎患者呼吸道并发症发生率,提高肺炎好转率及患者舒适度和日常生活活动能力。

关键词: 康复护理, 卒中, 吞咽障碍, 肺炎, 干预性研究

Abstract:

Objective: To analyze the intervention effect of nurse led rehabilitation management program on patients with pneumonia associated with dysphagia after stroke. Methods: The method of historical control study was used to select the patients with pneumonia associated with dysphagia after stroke who were hospitalized in the respiratory rehabilitation department of the Second Rehabilitation Hospital of Shanghai. The patients from January 1, 2021 to December 31, 2021 and from January 1, 2022 to December 31, 2022 were divided into the control group (87 cases) and the observation group (79 cases), respectively. The control group adopted a routine nursing model for stroke rehabilitation treatment (including neurological rehabilitation nursing routine, disease education, rehabilitation and drug treatment, respiratory care, etc.). A nurse led rehabilitation management plan based on the conventional nursing mode were provided in the observation group (including assessment of risk factors for pulmonary infection prognosis, establishment of rehabilitation management plan, tracking and evaluation of management effectiveness, etc.). The incidence of respiratory complications during hospitalization, the improvement rate of pneumonia at the second weekend of intervention, and the changes of comfort and activities of daily living (ADL) at the fourth weekend of intervention were compared between the two groups. Results: The incidence of respiratory complications in the observation group was 6.33% (5/79), significantly lower than that in the control group (20.69% (18/87)), and the difference was statistically significant (χ²=6.827, P=0.009). The improvement rate of pneumonia in the observation group at the end of the second week was 92.24% (73/79), which was significantly higher than that in the control group (80.46% (70/87)), and the difference was statistically significant (χ²=4.950, P=0.026). The comfort score and ADL score of the observation group at the end of the intervention fourth week were 57.25±8.54 and 56.90±10.20, respectively, higher than those of the control group ((48.29±7.34) and (49.37±10.70)), with statistically significant differences (t=-4.675 and -4.631, P values <0.05). Conclusion: The nurse led rehabilitation management program can reduce the incidence of respiratory complications in patients with dysphagia after stroke who have associated pneumonia, improve the improvement rate of pneumonia, and improve the comfort and activities of daily living of patients.

Key words: Rehabilitation nursing, Stroke, Deglutition disorders, Pneumonia, Intervention studies

中图分类号:

R493
R473.5

王琳, 司芬, 张梓楠. 护士主导的康复管理方案在脑卒中吞咽障碍相关性肺炎患者中的应用研究[J]. 结核与肺部疾病杂志, 2023, 4(4): 295-300. doi: 10.19983/j.issn.2096-8493.20230071

Wang Lin, Si Fen, Zhang Zinan. The application of nurse led rehabilitation management program in stroke patients with dysphagia associated pneumonia[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(4): 295-300. doi: 10.19983/j.issn.2096-8493.20230071

图/表 3

表1

两组脑卒中后吞咽障碍发生相关性肺炎患者基本资料比较

项目	对照组(87例)	观察组(79例)	统计检验值	P值
性别[例,构成比(%)]			χ²=1.573	0.210
男性	65(74.71)	52(65.82)
女性	22(25.29)	27(34.18)
年龄(岁, $x ˉ$ ±s)	67.28±4.86	66.75±5.61	t=1.723	0.085
脑卒中病程(d, $x ˉ$ ±s)	42.36±27.61	38.97±28.94	t=1.077	0.281
脑卒中诊断类型[例,构成比(%)]			χ²=1.459	0.227
出血型	50(57.47)	38(48.10)
缺血型	37(42.53)	41(51.90)
既往病史及不良习惯史[例,患病率(%)]
糖尿病	20(22.99)	23(29.11)	χ²=0.809	0.368
肺部基础疾病	8(9.20)	10(12.66)	χ²=0.514	0.474
高血压	64(73.56)	57(72.15)	χ²=0.042	0.838
高血脂	12(13.79)	10(12.66)	χ²=0.046	0.829
吸烟	34(39.08)	27(34.18)	χ²=0.428	0.513
饮酒	33(37.93)	25(31.65)	χ²=0.720	0.396
神经缺损程度[例,构成比(%)]			χ²=0.070	0.792
NIHSS 评分≥15分	37(42.53)	32(40.51)
NIHSS 评分<15分	50(57.47)	47(59.49)
留置胃管[例,留置率(%)]	39(44.82)	33(41.78)	χ²=0.157	0.692
洼田饮水试验分级[例,构成比(%)]			Z=2.537	0.126
Ⅲ级	25(28.74)	23(29.11)
Ⅳ级	33(37.93)	32(40.51)
Ⅴ级	29(33.33)	24(30.38)
咳嗽反射[例,构成比(%)]			χ²=0.403	0.526
正常	52(59.77)	51(64.56)
异常	35(40.23)	28(35.44)

表1

表2

表3

两组脑卒中后吞咽障碍发生相关性肺炎患者舒适度及ADL得分情况

组别	例数	舒适度(分, $x ˉ$ ±s)		t值	P值	ADL(分, $x ˉ$ ±s)		t值	P值
组别	例数	干预前	干预4周	t值	P值	干预前	干预4周	t值	P值
对照组	87例	42.28±9.56	48.29±7.34	-4.365	<0.001	41.90±12.09	49.37±10.70	-4.303	<0.001
观察组	79例	43.29±10.34	57.25±8.54	-7.933	<0.001	42.22±11.95	56.90±10.20	-8.307	<0.001
t值		-1.356	-4.675			-0.170	-4.631
P值		0.317	0.016			0.865	<0.001

表3

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并发症	对照组(87例)	观察组(79例)
肺不张	3	1
呼吸道梗阻	4	2
呼吸衰竭	5	1
误吸	6	2
窒息	3	1
合计	21	7