学科交叉式团队管理的膳食干预对ICU吞咽障碍高龄患者吸入性肺炎的影响

doi:10.3969/j.issn.2095-9400.2020.03.017

摘要
图/表
参考文献
相关文章 (5)

全文: PDF (1471 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：分析ICU吞咽障碍高龄患者引入学科交叉式团队管理的膳食干预对其吸入性肺炎的影响，为其临床诊疗管理提供循证依据。方法：选取2017年3月至2018年12月阜阳市第二人民医院ICU收治的96例吞咽障碍高龄患者，按随机数字表法将符合纳入标准的研究对象划分为研究组和对照组，每组48例。对照组实施传统护理干预；研究组实施学科交叉式团队管理的膳食干预。记录2组患者发生呛咳、拒食的例数及每餐摄食时间；比较2组患者在干预前和干预后第2周末吸入性肺炎的发生率。结果：研究组呛咳发生率、拒食率分别为4.2%、6.3%，低于对照组的16.7%、20.8%，每餐摄食时间为（17.3±2.1）min，短于对照组的（26.9±3.4）min，差异有统计学意义（P＜0.05）。干预后，研究组吸入性肺炎发生率为6.3%（3/48），低于对照组的16.7%（8/48），差异有统计学意义（P＜0.05）。结论：学科交叉式团队管理的膳食干预应用于ICU吞咽障碍高龄患者，能降低吸入性肺炎的发生率，减少潜在不良事件的发生率。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	孟晓敏
	王莹莹
	杨永利
	黄敏

关键词 ： ICU, 吞咽障碍, 高龄人群, 学科交叉, 团队管理, 膳食干预, 吸入性肺炎

Abstract：Objective: To analyze the effect of dietary intervention with interdisciplinary team management on inhalation pneumonia in elderly patients with dysphagia in ICU, and to provide evidence-based support for clinical diagnosis and treatment management of these groups. Methods: A total of 96 elderly patients with dysphagia who were treated in ICU of NO.2 People’s Hospital of Fuyang City from March 2017 to December 2018 were collected. According to the random number table, the subjects who met the inclusion criteria were divided into study group and control group, with 48 cases in each group. Among them, the control group was given traditional nursing intervention, while the research group was given dietary intervention with interdisciplinary team management. The cases of cough and Antifeedant were recorded, and the time of eating per meal was compared between the two groups. The incidence of aspiration pneumonia before and after the intervention was compared between the two groups. Results: The incidence of cough and antifeeding in the study group were 4.2% and 6.3% respectively, which were lower than those in the control group (16.7% and 20.8%). The feeding time per meal was (17.3±2.1) min, which was shorter than that in the control group (26.9±3.4) min, with significant difference (P<0.05). After intervention, the incidence of inhalation pneumonia in the study group was 6.3% (3/48), lower than that in the control group (16.7%; 8/48), with significant difference (P<0.05). Conclusion: Interdisciplinary team-managed dietary intervention in elderly patients with dysphagia in ICU can reduce the incidence of aspiration pneumonia, reduce the incidence of potential adverse events, which enables patients to obtain a certain nutritional reserve in the recovery period.

Key words： ICU dysphagia elderly population interdisciplinary team management dietary intervention inhalation pneumonia

基金资助:宁波市卫计委项目（2016A601011）。

通讯作者: 黄敏，副主任护师，Email：Hmfy333@sohu.com。

作者简介: 孟晓敏（1984-），女，安徽阜阳人，主管护师。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.017 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/249

[1] 李俐, 方燕丽, 张冬宁, 等. 吞咽障碍筛查联合吞糊实验在机械通气病人经口进食中的应用研究[J]. 护理研究, 2014(17): 2109-2110.
[2] SCHEFOLD J C, BERGER D, ZÜRCHER P, et al. Dysphagia in mechanically ventilated ICU patients (DYnAMICS): A prospective observational trial[J]. Crit Care Med, 2017, 45(12): 2061-2069.
[3] BRODSKY M B, HUANG M, SHANHOLTZ C, et al. Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors, A 5-year longitudinal study[J]. Ann Am Thorac Soc, 2017, 14(3): 376-383.
[4] 王健红, 陈巧玲. 循证护理在误吸老年患者吞咽障碍康复训练中的应用[J]. 齐鲁护理杂志, 2016, 22(23): 23-25.
[5] VAN SNIPPENBURG W, KRÖNER A, FLIM M, et al. Awareness and management of dysphagia in dutch intensive care units: A nationwide survey[J]. Dysphagia, 2019, 34(2): 220-228.
[6] 崔丽萍, 冯晓芳, 陈晓青, 等. 吞咽功能评估表及早期康复训练对降低老年吞咽障碍病人吸入性肺炎发生率的效果分析[J]. 护理研究, 2016, 30(36): 4548-4550.
[7] MAHMODLOU R, SHATERI K, HOMAYOONI F, et al. The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer[J]. Gastroenterol Rep, 2017, 5(1): 52-56.
[8] 韦艳燕. 吞咽训练联合穴位按摩对脑卒中患者吞咽障碍的效果观察[J]. 护理学报, 2016, 23(23): 67-70.
[9] RUMBACH A F, CREMER R. Dysphagia and speech-language pathology involvement following chemical ingestion injury: A review of 44 cases admitted to a quaternary australian hospital (2008-2012)[J]. Am J Speech Lang Pathol, 2017, 26(4): 1120-1128.
[10] 刘波, 张芳, 刘亚川, 等. 针灸联合吞咽障碍治疗仪治疗早期脑卒中后吞咽障碍的疗效研究[J]. 中国基层医药, 2016, 23(13): 1986-1990.
[11] YAZDANNIK A, ATASHI V, GHAFARI S. Performance of ICU nurses in providing respiratory care[J]. Iran J Nurs Midwifery Res, 2018, 23(3): 178-182.
[12] WIRTH R, POURHASSAN M, STREICHER M, et al. The impact of dysphagia on mortality of nursing home residents: results from the nutrition day project[J]. J Am Med Dir Assoc, 2018, 19(9): 775-778.
[13] DARAWAD M W, ALFASFOS N, ZAKI I, et al. ICU nurses’ perceived barriers to effective enteral nutrition practices: A multicenter survey study[J]. Open Nurs J, 2018, 12: 67-75.
[14] 顾志娥, 俞龙, 刘必琴, 等. 临床护理路径在急性脑梗死吞咽障碍中的应用研究[J]. 实用临床医药杂志, 2015(14): 7-10.
[15] HASSAN E. Tele-ICU and patient safety considerations[J]. Crit Care Nurs Q, 2018, 41(1): 47-59.
[16] 王昕. 改良吞咽障碍筛查在降低急性脑卒中患者吸入性肺炎中的应用[J]. 现代诊断与治疗, 2015(17): 4001-4002.
[17] TAN L, GAN G, HUM A, et al. A stepwise, mixed-method study approach to identify the barriers to dysphagia care in hospice care nurses[J]. J Hosp Palliat Nurs, 2018, 20(1): 88-94.
[18] 安春梅. 早期康复护理在重症病毒性脑炎患者吞咽障碍中的应用[J]. 齐鲁护理杂志, 2016, 22(5): 98-99.
[19] CHIANG C K, HWU Y J. Feeding experiences of nursing aides for residents with dysphagia[J]. Geriatr Nurs, 2018, 39(4): 436-442.