首发脑卒中患者吞咽障碍居家饮食护理方案的制订及应用

doi:10.3761/j.issn.0254-1769.2019.07.003

摘要/Abstract

摘要：

目的制订首发脑卒中患者吞咽障碍居家饮食护理方案,并探讨其应用效果。方法 2017年7月—2018年6月,便利选取某三级甲等医院神经内科收治的3~4级吞咽障碍的首发脑卒中患者,一病区的30例患者纳入试验组,二病区的30例患者纳入对照组。试验组接受居家饮食护理方案,对照组接受常规饮食指导。出院3个月后,观察两组吸入性肺炎的发生情况、吞咽功能和生活质量的变化。结果出院后3个月,两组吸入性肺炎发生率的比较,差异有统计学意义（P<0.05）。出院后1个月、3个月,试验组的吞咽功能优于对照组,差异均有统计学意义（P<0.05）。出院后1个月,试验组的生活质量在进食时间、症状频率、选择食物、恐惧、心理健康、疲劳程度、心理负担、进食欲望、社会交往维度得分高于对照组,差异有统计学意义（P<0.05）,两组在语言交流、睡眠维度得分的比较,差异无统计学意义（P>0.05）;出院后3个月,试验组进食时间、症状频率、选择食物、恐惧、心理健康、疲劳程度、心理负担、进食欲望、社会交往及睡眠维度得分高于对照组,差异有统计学意义（P<0.05）,两组语言交流维度得分比较,差异无统计学意义（P>0.05）。结论首发脑卒中患者吞咽障碍居家饮食护理方案能有效预防吸入性肺炎的发生,提高患者的吞咽功能和生活质量。

关键词: 卒中后吞咽障碍, 膳食标准, 饮食方案, 康复护理

Abstract:

Objective To develop dietary nursing scheme for patients with dysphagia after first stroke,and to explore the effects of application.Methods From July 2017 to June 2018,60 patients with grade 3 or 4 dysphagia after the first stroke were conveniently selected from neurology department of a tertiary hospital. Thirty patients in Ward One were included in the experimental group,and 30 patients in Ward Two were included in the control group. The experimental group was given a home-based dietary nursing scheme,and the control group was given routine dietary guidance. Three months after discharge,incidence of inhaled pneumonia,swallowing function and quality of life in two groups were compared.Results Three months after discharge,there was a significant difference in the incidence of pneumonia between two groups（P<0.05）. The score of swallowing function was significantly higher in the experimental group than that in the control group at 1 month and 3 months after discharge（P<0.05）. One month after discharge,quality of life in terms of eating time,symptom rate,food selection,fear,mental health,fatigue degree,psychological burden,eating desire and social interaction in the experimental group were better than those in the control group,and the differences were statistically significant（P<0.05）,but there were no significant differences in language communication and sleep between two groups（P>0.05）. At 3 months after discharge,the experimental group was superior to the control group in eating time,symptom rate,food selection,fear,mental health,fatigue degree,psychological burden,eating desire,social interaction and sleep,and the differences were statistically significant（P<0.05）. There was no significant difference in language communication between two groups（P>0.05）.Conclusion The home-based dietary nursing scheme for patients with dysphagia after first stroke can effectively prevent the occurrence of inhaled pneumonia and improve swallowing function and quality of life.

Key words: Dysphagia after Stroke, Dietary Standard, Dietary Plan, Rehabilitation Nursing

吕孟菊, 柳俊杰, 王艳冬. 首发脑卒中患者吞咽障碍居家饮食护理方案的制订及应用[J]. 中华护理杂志, 2019, 54(7): 975-980.

Lü Mengju, LIU Junjie, WANG Yandong. Development and application of dietary nursing scheme for patients with dysphagia after first stroke[J]. Chinese Journal of Nursing, 2019, 54(7): 975-980.

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