集束化护理对脑卒中吞咽功能障碍患者康复效果及生存质量的影响研究

摘要

Objective To investigate the impact of rehabilitation and quality of life in patients of with cluster nursing for stroke swallowing dysfunction. Methods 84 stroke patients of stroke swallowing dysfunction were divided into observation group(n=42)and the control group(n=42)in Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University from January to December 2013. The control group were implemented with routine rehabilitation care and the observation group were implemented with cluster nursing. The mental status, activities of daily living, neurological deficit, swallowing function and quality of life of two group were evaluated with Hamilton Anxiety scale ( HAMA ) and Hamilton Depression scale(HAMD),assessment of activities of daily living(Barthel)index,the United states National Institutes of Health stroke scale( NIHss),Kubota test,chronic disease rating scale quality of life( QOL). Results The HAMA,HAMD scores of observation group after nursing were lower than control group(P<0. 05);HAMA,HAMD scores after nursing were lower than before nursing between the two group ( P<0. 05 ). The Barthel score of observation group after nursing were higher than control group and the NIHss score of observation group after nursing were lower than control group ( P <0. 05 ). The swallowing dysfunction score of two groups after nursing were decreased than before nursing( P < 0. 05 ). The swallowing dysfunction score of observation group after nursing were decreased than the control group(P<0. 05). The nursing psychology, physiology scores of adaptive social dimension of quality of life scores and scores of observation group after treatment were higher than control group ( P < 0. 05 ). Conclusion Cluster nursing can improve swallowing dysfunction in patients with stroke rehabilitation,to improve their quality of life.%目的：探讨集束化护理对脑卒中吞咽功能障碍患者康复效果及生存质量的影响。方法选取温州医科大学附属第一医院神经内科2013年1—12月收治的84例脑卒中吞咽功能障碍患者为研究对象，采用随机数字表法将其分为观察组和对照组，各42例。对照组患者实施常规康复护理，观察组患者在实施常规康复护理基础上实施集束化护理。护理前后采用汉密尔顿焦虑量表（ HAMA ）、汉密尔顿抑郁量表（ HAMD ）、日常生活能力评定指数量表（ Barthel）、美国国立卫生研究院脑卒中量表（ NIHSS）、洼田试验、慢性疾病生存质量评分量表（ QOL）对两组患者心理状况、日常生活能力、神经功能缺损、吞咽功能及生存质量进行评价。结果护理后观察组患者HAMA、HAMD评分低于对照组（ P＜0.05）；两组患者护理后 HAMA、HAMD 评分均较护理前降低（ P ＜0.05）。护理后观察组患者Barthel评分高于对照组，NIHSS评分低于对照组（P＜0.05）；两组护理后Barthel评分均较护理前升高，NIHSS评分均较护理前降低（P＜0.05）。护理后观察组吞咽功能优于对照组（P＜0.05）；两组护理后吞咽功能均优于护理前（P＜0.05）。护理后观察组心理维度得分、生理维度得分、社会适应性维度得分以及生存质量总分均高于对照组（ P ＜0.05）；观察组护理后心理维度得分、生理维度得分、社会适应性维度得分以及生存质量总分均较护理前升高（ P＜0.05）。结论集束化护理能有效提高脑卒中吞咽功能障碍患者的康复效果，改善其生存质量。