协同护理在脑卒中后吞咽障碍康复训练中的作用

何丽明 梁伟容 肖鹏 王玉龙

[摘要]目的 探討协同护理（CCM）在脑卒中后吞咽障碍（DSA）康复训练中的作用，为临床提供可靠的依据。方法 选取2014年3月～2017年4月来我院就诊并诊断为DSA的患者98例作为研究对象，随机平均分成实验组和参照组，每组各49例。两组患者都行常规治疗，实验组患者在参照组的基础上采用CCM模式。比较两组患者治疗前后的吞咽障碍程度、临床疗效以及患者的满意度。结果 干预治疗后，实验组患者总有效率为95.92%，高于参照组（81.63%），差异有统计学意义（P<0.05）。干预治疗前，两组患者的吞咽困难评分比较，差异无统计学意义（P>0.05）；干预治疗后，实验组患者的吞咽困难评分为（2.25±0.87）分，明显低于参照组（4.31±0.64）分，差异有统计学意义（P<0.05）。实验组患者总满意率为87.76%，高于实验组（63.35%），差异有统计学意义（P<0.05）。结论 CCM护理模式在DSA康复训练中具有较好的治疗效果，能够提高患者的日常生活能力，改善DSA患者的吞咽功能障碍，减少患者不良情绪的发生，在临床治疗中值得推广应用。

[关键词]协同护理；脑卒中；吞咽障碍；康复训练

[中图分类号] R473.74 [文献标识码] A [文章编号] 1674-4721（2018）4（a）-0188-03

Effect of collaborative care nursing on rehabilitation training of swallowing disorder after stroke

HE Li-ming LIANG Wei-rong XIAO Peng WANG Yu-long▲

Department of Rehabilitation，Nan′ao People′s Hospital of Dapeng New District in Shenzhen City，Guangdong Province，Shenzhen 518121，China

[Abstract]Objective To explore the role of collaborative care nursing （CCM） in rehabilitation training for post-stroke dysphagia （DSA） and provide a reliable basis for clinical.Methods A total of 98 patients with DSA were selected from March 2014 to April 2017.The patients were randomly divided into experimental group and reference group，49 cases in each group.The two groups were treated with routine therapy.Patients of the experimental group was given CCM mode on the basis of the reference group.The degree of dysphagia，clinical efficacy and satisfaction of the two groups before and after treatment were compared.Results After intervention，the total effective rate of the experimental group was 95.92%，which was higher than 81.63% of the reference group，the difference was statistically significant （P<0.05）.Before intervention，the scores of dysphagia in two groups of patients were compared，the difference was not statistically significant（P>0.05）.The score of dysphagia in experimental group after intervention was （2.25±0.87） point，which was significantly lower than that of the reference group （[4.31±0.64] point），the difference was statistically significant （P<0.05）.The satisfaction rate of experimental group was 87.76%，which was higher than that of reference group（63.35%），the difference was statistically significant （P<0.05）.Conclusion CCM nursing model has a good therapeutic effect in DSA rehabilitation training，can improve the daily life ability of patients，improve the swallowing dysfunction of DSA patients，reduce the occurrence of adverse emotions in patients，and should be popularized in clinical treatment.

[Key words]Dysphagiative care model；Stroke；Dysphagia；Rehabilitation

吞咽障碍（dysphagia）是脑卒中患者的一种并发症，其发病原理为两侧皮质延髓束受到破损，受其支配的肌肉瘫痪，最终导致咀嚼无力、进食呛咳以及吞咽困难[1]。据统计，脑卒中后有50%～72%的患者会出现吞咽功能障碍[2]，如果得不到有效治疗，极易导致营养不良，出现低血糖以及食物误吸等症状，严重影响患者的生活质量以及危害生命[3]。如何有效地预防并且减少脑卒中后吞咽障碍（dysphagia after stroke，DSA）的发生已成为医学界关注的焦点。有研究报道，协同护理（collaborative care model，CCM）的宗旨是健康教育及辅助支持，通过发挥患者的自我护理以及健康决策能力，加快患者的康复速度[4]。本研究探讨CCM在DSA康复训练中的作用，现报道如下。

1资料与方法

1.1一般资料

选取2014年3月～2017年4月我院就診并诊断为DSA的患者98例作为研究对象，随机分成实验组和参照组，每组各49例。……