The application of nurse led rehabilitation management program in stroke patients with dysphagia associated pneumonia

doi:10.19983/j.issn.2096-8493.20230071

Abstract

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

CLC Number:

R493
R473.5

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

Figures/Tables 3

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)

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

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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