脑卒中吞咽障碍患者居家护理模式及效果评价
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摘要
目的:构建脑卒中吞咽障碍患者居家护理模式并评价其效果。方法:选取脑卒中吞咽障碍患者78例为研究对象。采用计算机产生随机序列法将患者随机分为观察组和对照组,每组各39例。对照组给予常规健康教育,观察组在常规健康教育基础上给予居家护理服务计划和干预措施,干预12周后,评价并比较2组患者干预前后的吞咽障碍情况、神经功能缺损程度、营养风险、自理能力、日常活动能力、心理状态及康复依从性。结果:干预12周后,2组吞咽障碍功能较治疗前明显提高(P<0.05),且观察组更优于对照组(P<0.05)。干预后,观察组患者神经功能缺损、营养风险、抑郁评分明显低于干预前及对照组(均P<0.05),观察组患者自理能力、日常活动能力、依从性得分均高于干预前及对照组(均P<0.05);对照组各项指标干预前后比较除营养风险和抑郁评分外,其余各项指标差异有统计学意义(均P<0.05)。结论:脑卒中吞咽障碍患者居家护理模式有较高的实用价值,对改善脑卒中吞咽障碍患者吞咽情况,提高患者生活质量,促进患者康复,实现医院-社区-家庭的无中断长期护理服务有重要作用。
Objective: To construct and evaluate the home care mode of stroke patients with dysphagia. Methods: Seventy-eight stroke patients with dysphagia who visited our hospital from July 2017 to May 2018 were selected as subjects. Using computer generated random sequence method, the patients were randomly divide into experimental group and control group, 39 cases in each group, General health education would be taken to the control group and a door-to-door home care, which is on the basis of general health education, would be taken to the experimental group at the same time. At the week 12 of the intervention, the swallowing disorder, neurological deficit, nutrition risk, self-care ability, daily activities, psychological status and rehabilitation compliance were evaluated and compared between the two groups before and after intervention. Results: After treatment, swallowing dysfunction of the two groups was significantly improved as compared with that before treatment(P<0.05), more significant in the observation group than in the control group(P<0.05). After 12 weeks of intervention, the scores of neurological deficit, nutrition risk and depression in the experimental group were significantly lower than those before intervention and in the control group(P<0.05). The scores of self-care ability, daily activity ability and compliance in the experimental group were significantly higher than those before intervention and in the control group(P<0.05). Before and after the intervention, all the indicators in the control group had statistically significant differences except for nutritional risk and depression score(P<0.05). Conclusion: Home care for stroke patients with dysphagia has higher practica value, and it plays an important role in improving the swallowing condition of stroke patients with dysphagia, improving the quality of life of patients, promoting the rehabilitation of patients, and realizing the uninterrupted long-term care service of hospital-community-family.
Objective: To construct and evaluate the home care mode of stroke patients with dysphagia. Methods: Seventy-eight stroke patients with dysphagia who visited our hospital from July 2017 to May 2018 were selected as subjects. Using computer generated random sequence method, the patients were randomly divide into experimental group and control group, 39 cases in each group, General health education would be taken to the control group and a door-to-door home care, which is on the basis of general health education, would be taken to the experimental group at the same time. At the week 12 of the intervention, the swallowing disorder, neurological deficit, nutrition risk, self-care ability, daily activities, psychological status and rehabilitation compliance were evaluated and compared between the two groups before and after intervention. Results: After treatment, swallowing dysfunction of the two groups was significantly improved as compared with that before treatment(P<0.05), more significant in the observation group than in the control group(P<0.05). After 12 weeks of intervention, the scores of neurological deficit, nutrition risk and depression in the experimental group were significantly lower than those before intervention and in the control group(P<0.05). The scores of self-care ability, daily activity ability and compliance in the experimental group were significantly higher than those before intervention and in the control group(P<0.05). Before and after the intervention, all the indicators in the control group had statistically significant differences except for nutritional risk and depression score(P<0.05). Conclusion: Home care for stroke patients with dysphagia has higher practica value, and it plays an important role in improving the swallowing condition of stroke patients with dysphagia, improving the quality of life of patients, promoting the rehabilitation of patients, and realizing the uninterrupted long-term care service of hospital-community-family.
引文
[1] 中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍康复评估与治疗专家共识(2013年版)[J].中华物理医学与康复杂志,2013,35(12):916-929.
[2] 石媛.早期康复护理干预对脑卒中吞咽障碍患者功能恢复的影响[J].中医临床研究,2015(27):49-50.
[3] 葛明玉,邱定金,钱国利,等.居家脑卒中吞咽障碍患者的社区护理干预体会[J].护理与康复,2012,11(6):588-589.
[4] 陈璐,陈湘玉,沈小芳,等.居家护理服务模式的构建[J].中国护理管理,2014,14(02):195-197.
[5] 黄如训,苏镇培.脑卒中[M].北京:人民卫生出版社,2001:345-346.
[6] 黄如训,苏镇培.脑卒中[M].北京:人民卫生出版社,2001:345-346.
[7] 邢欢,刘丽.延续护理方案在脑卒中患者中的应用效果评价[J].中国现代医生,2013,51(15):103-105.
[8] Geeganage C,Beavan J,Ellender S,et al.Interventions for dysphagia and nutritional support in acute and subacute stroke[J].Cochrane Database Syst Rev,2012,Oct 17;10:CD000323.
[9] 祁鑫华,姬小娜.家庭护理对吞咽障碍患者术后影响[J].解放军医院管理杂志,2016,23(12):1187-1189.
[10] Ickenstein G W,Hohlig C,Prosiegel M,et al.Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke[J].J Stroke Cerebrovasc Dis,2012,21(7):569-576.
[11] 蒋亚斌,李国成.脑卒中后抑郁及抗抑郁治疗对患者神经功能恢复影响的Meta分析[J].中国临床康复,2004,8(31):6829-6831.
[12] 池万章,池丽芬,周强,等.脑卒中后吞咽障碍多因素分析及对预后的影响[J].心脑血管病防治,2009,9(3):177-178.
[13] 石向群,杨金升,杨树琛,等.吞咽障碍对急性脑卒中患者营养及神经康复的影响[J].中国临床康复,2003,7(19):2704-2705.
[14] 谢家兴,牛敬雪,张红云,等.脑卒中吞咽障碍康复结局的影响因素[J].中国康复理论与实践,2015,21(11):1352-1355.
[15] 李玲.综合性护理干预对脑卒中患者神经功能恢复的影响[J].医学理论与实践,2017,30(5):764-766.
[16] 刘玲玉,翟华,王惠芳,等.多学科团队管理对脑损伤吞咽障碍患者吞咽功能的影响[J].中国康复,2018,33(05):373-376.
[17] 孙素娟,赵景茹,赵秀娟,等.综合康复护理干预对脑卒中患者抑郁及神经功能康复的疗效观察[J].中国康复,2016,31(4):294-295.
[18] 李琴,李春花,孙玲,等.延续护理对脑卒中病人日常生活能力影响的Meta分析[J].护理研究,2018,32(13):2075-2083.
[19] 涂淑华,王真真,彭雨燕,等.延续性护理对脑卒中患者日常生活能力和依从性影响的Meta分析[J].中国当代医药,2017,24(15):4-8.
[2] 石媛.早期康复护理干预对脑卒中吞咽障碍患者功能恢复的影响[J].中医临床研究,2015(27):49-50.
[3] 葛明玉,邱定金,钱国利,等.居家脑卒中吞咽障碍患者的社区护理干预体会[J].护理与康复,2012,11(6):588-589.
[4] 陈璐,陈湘玉,沈小芳,等.居家护理服务模式的构建[J].中国护理管理,2014,14(02):195-197.
[5] 黄如训,苏镇培.脑卒中[M].北京:人民卫生出版社,2001:345-346.
[6] 黄如训,苏镇培.脑卒中[M].北京:人民卫生出版社,2001:345-346.
[7] 邢欢,刘丽.延续护理方案在脑卒中患者中的应用效果评价[J].中国现代医生,2013,51(15):103-105.
[8] Geeganage C,Beavan J,Ellender S,et al.Interventions for dysphagia and nutritional support in acute and subacute stroke[J].Cochrane Database Syst Rev,2012,Oct 17;10:CD000323.
[9] 祁鑫华,姬小娜.家庭护理对吞咽障碍患者术后影响[J].解放军医院管理杂志,2016,23(12):1187-1189.
[10] Ickenstein G W,Hohlig C,Prosiegel M,et al.Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke[J].J Stroke Cerebrovasc Dis,2012,21(7):569-576.
[11] 蒋亚斌,李国成.脑卒中后抑郁及抗抑郁治疗对患者神经功能恢复影响的Meta分析[J].中国临床康复,2004,8(31):6829-6831.
[12] 池万章,池丽芬,周强,等.脑卒中后吞咽障碍多因素分析及对预后的影响[J].心脑血管病防治,2009,9(3):177-178.
[13] 石向群,杨金升,杨树琛,等.吞咽障碍对急性脑卒中患者营养及神经康复的影响[J].中国临床康复,2003,7(19):2704-2705.
[14] 谢家兴,牛敬雪,张红云,等.脑卒中吞咽障碍康复结局的影响因素[J].中国康复理论与实践,2015,21(11):1352-1355.
[15] 李玲.综合性护理干预对脑卒中患者神经功能恢复的影响[J].医学理论与实践,2017,30(5):764-766.
[16] 刘玲玉,翟华,王惠芳,等.多学科团队管理对脑损伤吞咽障碍患者吞咽功能的影响[J].中国康复,2018,33(05):373-376.
[17] 孙素娟,赵景茹,赵秀娟,等.综合康复护理干预对脑卒中患者抑郁及神经功能康复的疗效观察[J].中国康复,2016,31(4):294-295.
[18] 李琴,李春花,孙玲,等.延续护理对脑卒中病人日常生活能力影响的Meta分析[J].护理研究,2018,32(13):2075-2083.
[19] 涂淑华,王真真,彭雨燕,等.延续性护理对脑卒中患者日常生活能力和依从性影响的Meta分析[J].中国当代医药,2017,24(15):4-8.