郜艳丽;

• 1:郑州大学附属郑州中心医院

摘要(Abstract)：

目的分析针对性护理干预对重症脑卒中伴吞咽困难患者营养状态的影响。方法选取132例重症脑卒中并发吞咽困难的患者,随机分为实验组68例,对照组64例。实验组采取针对性护理干预进行护理;对照组采用常规护理。结果试验组采用针对性护理措施10d后TP,ALB、Hb值均高于对照组;2组治疗10d血糖异常率、感染发生率及住院时间比较差异具有统计学意义(P<0.05)。结论针对性护理措施可明显提升重症脑卒中伴吞咽困难患者的全身营养状态,减少血糖异常率及患者感染发生率,减少监护室入住时间,对患者早期康复具有重要作用。

关键词(KeyWords)： 脑卒中;吞咽困难患者;营养风险筛查;针对性护理;护理干预

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 郜艳丽;

参考文献(References)：

• [1] MARTINO R,FOLEY N,BHOGAL S,et al.Dysphagia after stroke:incidence,di-agnosis,and pulmonary complications[J].Stroke,2005,36(12):2756-2763.
• [2] SMITH-HAMMOND C A,GOLDSTEIN L B,ZAJAC D J,et al.Assessment of aspira-Tion risk in stroke patients with quantification of voluntary cough[J].Neurology,2001,56(4):502-6.
• [3] Stroke--1989.Recommendations on stroke prevention,diagnosis,and therapy.Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders[J].S troke,1989,20(10):1407-1431.
• [4] WADDINGTON H.Psychological and communication issues in feeding post-stroke patients with dysphagia[J].Nurs Times,2011,105(32/33):25-26.
• [5] ALSHEKHLEE A,RANAWAT N,SYED T,et al.National institutes of health stroke scale assists inpredicting the need for percuta-neous endoscopic gastrostomy tube placement in acute ische-micstroke[J].J Stroke Cerebrovasc Dis,2010,19(5):347-352.
• [6] EMESSO G C,FUKUJIMA M M,CHIAPPETTA A L,et al.Swallowing disorders after ischemicstroke[J].Arq Neurop siquiatr,2011,69(5):785-789.
• [7] HIIKER R,POETTER C,FINDEISEN N,et al.Nosocomial pneumonia after a-cute stroke:implications for neurological intensive care medicine[J].Stroke(S0039-2499),2003,34(4):975-981.
• [8] RAMSEY D J,SMITHARD D G,KALRA L.Early assessments of dysphagia and aspiration risk in acute stroke patients[J].2003,34(5):1252-1257.
• [9] BERNHARDT J.Very early mobilization following acute stroke:Controver-sies,the unknowns,and a way forward[J].An Indian Acad Neurol,2008,11(5):88-98.
• [10] BERNHARDT J,INDREDAVIK B,DEWEY H,et al.Mobilisation‘in Bed’is not mobilisation[J].Cerebrovasc Dis,2007,24(1):157-158.
• [11] MENG N H,WANG T G,LIEN I N.Dysphagia in patients with brainstem stroke:incidence and outcome[J].Am Phys Med Rehabil,2000,79(2):170-175.
• [12] MAHLER M P,ZUGER K,KASPAR K,et al.A cost analysis of the first year after stroke-early triage and inpatient rehabilitation may reduce long term costs[J].Swiss Med Wkly,2008,138(31-32):459-465.
• [13] CHANG S J,HUANG H H.Diarrhea in enterally fed patients:Blame the diet[J].Curr Opin Clin Nutr Metab Care,2013,16(5):588-594.
• [14] LAKSHMINARAYAN K,TSAI A W,TONG X,et al.Utility of dysphagia screening results in predicting poststroke pneumonia[J].Stroke,2010,41:2849-2854.
• [15] KREYMANN K G,BERGER M M,DEUTZ N E,et al.Espen guidelines on enteral nutrition:Intensive care[J].Clin Nutr,2006,25:210-223.
• [16] TEITELBAUM D,GUENTER P,HOWELL W H,et al.Definition of terms,style,and conventions used in A.S.P.E.N.guidelines and standards[J].Nutr Clin Pract,2005,20:281-285.
• [17] SMITHARD D G,SMEETON N C,WOLFE C D.Long-term outcome after stroke:does dysphagia matter[J].Age Ageing,2007,36:90-94.
• [18] FOLEY N C,MARTIN R E,SALTER K L,et al.A review of the relationship between dysphagia and malnutrition following stroke[J].J Rehabil Med,2009,41:707-713.
• [19] MOSSELMAN M J,KRUITWAGEN C L,SCHUURMANS M J,et al.Malnutrition and risk of malnutrition in patients with stroke:Prevalence during hospital stay[J].J Neurosci Nurs,2013,45:194-204.
• [20] SNOEK S A,VERSTEGE M I,BOECKXSTAENS G E,et al.The enteric nervous system as a regulator of intestinal epithelial barrier function in health and disease[J].Expert Rev Gastroenterol Hepatol,2010,4:637-651.
• [21] HUTCHINSON E,WILSON N.Acute stroke,dysphagia and nutritional support[J].Br J Community Nurs,2013,Suppl:S26-S29.
• [22] CORRIGAN M L,ESCURO A A,CELESTIN J,et al.Nutrition in the stroke patient[J].Nutr Clin Pract,2011,26:242-252.
• [23] SHERRILL L,SUSAN R.Early intervention care in the acute stroke patient[J].Arch PhysMed Rehabil,1986,67:319.
• [24] GARCIA J M,CHAMBERS E 4TH.Managing dysphagia through diet medifications[J].Am J Nurs,2010,110:26-33.
• [25] MCCLAVE S A,MARTINDALE R G,VANEK V W,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)[J].JPEN,2009,33:277-316.
• [26] MILNE A C,POTTER J,AVENELL A.Protein and energy supplementation in elderly people at risk from malnutrition[J].Cochrane Database Syst Rev,2009,15(2):CD003288.
• [27] NIGHTINGALE J M,WALSH N,BULLOCK M E,et al.Three simple methods of detecting malnutrition on medical wards[J].J R Soc Med,1996,89:144-148.
• [28] KLANG M,MCLYMON V,Ng N.Osmolality,pH,and compatibility of selected oral liquid medications with an enteral nutrition product[J].JPEN J Parenter Enteral Nutr,2013,37(5):689-694.
• [29] ANTONIOS N,CARNABY-MANN G,CRARY M,et al.Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit:the Modified Mann Assessment of Swallowing Ability[J].J Stroke Cerebrovasc Dis,2010,19:49-57.
• [30] EMESSO G C,FUKUJIMA M M,CHIAPPETTA AL,et al.Swallowing disorders after ischemicstroke[J].Arq Neurop siquiatr,2011,69(5):785-789.
• [31] BEAVAN J,CONROY S P,HARWOOD R,GLADMAN J R,et al.Treatment of dysphagia improves nutritional condition in stroke patients[J].Age Ageing,2010,39(5):624-630.