多维度康复管理模式在卒中后吞咽障碍患者康复中的应用
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上海市黄浦区青年医师培养资助计划(2021QN07);上海市卫生健康委员会卫生行业临床研究专项面上项目(202240203)


The intervention effect of multidimensional rehabilitation management mode on patients with dysphagia after stroke
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    目的 探讨多维度康复管理模式在卒中后吞咽障碍患者中的应用价值。方法 选取 2019年12月至2021年10月上海市瑞金康复医院收治的66例卒中后吞咽障碍患者为研究对象,其中对照组 35例来自综合康复病区,采用常规综合康复干预方案;观察组31例来自脑病康复病区,在对照组的基础 上采用包括多学科协作管理、风险管理和精细化管理3个维度的多维度康复管理模式进行干预。分别于 干预前、干预3周后采用洼田饮水试验和吞咽造影检查(VFSS)、渗漏误吸量表(PAS)评价两组患者的吞咽 功能,采用功能性经口摄食量表(FOIS)评估患者的进食功能水平,通过患者血清白蛋白水平测定评估营 养状态,采用中文版SWAL-QOL评估两组患者的生活质量。结果 观察组的吞咽功能康复总有效率为 87.1%(27/31),高于对照组的64.6%(26/35),差异有统计学意义(χ2 =6.150,P< 0.05)。干预后两组患者的VFSS 评分和FOIS评分均高于干预前,且干预后观察组的VFSS评分高于对照组[(8.32±1.28)比(7.03±1.86)分], FOIS 评分高于对照组[5.0(4.0,6.0)比 3.0(1.0,6.0)分],差异有统计学意义(t=3.260,Z=-3.196;均P< 0.01)。干预后观察组患者的 PAS 评分低于对照组[1.0(1.0,1.0)比 2.0(1.0,5.0)分],差异有统计学意义 (Z=-2.429,P< 0.05)。观察组干预后的血白蛋白水平高于干预前[(33.44±3.19)比(30.90±3.34)g/L], 差异有统计学意义(t=6.528,P< 0.01)。两组患者的中文版 SWAL-QOL 评分较干预前升高,且干预后观 察组的评分高于对照组[135.0(129.0,149.0)比 103.0(94.0,136.0)分],差异有统计学意义(Z=-3.023,P< 0.01)。结论 多维度康复管理模式对保证卒中后吞咽障碍患者的营养需求、改善吞咽功能、提高生活 质量具有积极作用。

    Abstract:

    Objective To explore the application value of multidimensional rehabilitation management mode in patients with dysphagia after stroke. Methods A total of 66 patients with dysphagia after stroke in Shanghai Ruijin Rehabilitation Hospital between December 2019 and October 2021 were selected as the subjects. In the control group, 35 cases were from the comprehensive rehabilitation ward, and the routine comprehensive rehabilitation intervention program was adopted. In the observation group, 31 cases were from the encephalopathy rehabilitation ward. On the basis of the control group, the multidimensional rehabilitation management mode including multidisciplinary collaboration, risk management and delicacy management was used for intervention. The swallowing function of both groups was evaluated respectively by Sub-water Test Score, Videofluoroscopic Swallowing Study (VFSS) and Penetration Aspiration Scale (PAS) before and after the 3 weeks' intervention. The functional level of intake of food and liquid was evaluated by Functional Oral Intake Scale (FOIS). Nutritional status was assessed by measuring serum albumin level. The Chinese version of Swallowing-Quality of Life(SWAL-QOL) was used to assess the quality of life. Results The total effective rate in the observation group was 87.1% (27/31), higher than that in the control group 64.6% (26/35), the difference was statistically significant (χ2 =6.150, P < 0.05). After the intervention, the VFSS and FOIS scores of the 2 groups were higher than before (P < 0.05). After the intervention, the VFSS score of the observation group was higher than that of the control group[ (8.32±1.28) vs (7.03±1.98) points]. After the intervention, the FOIS score of the observation group was higher than that of the control group [5.0(4.0,6.0) vs 3.0(1.0,6.0) points], and the difference was statistically significant (t=3.260, Z=-3.196; all P < 0.01). After the intervention, the PAS score of the observation group was lower than that of the control group [1.0 (1.0,1.0) vs 2.0 (1.0, 5.0) points], and the difference was statistically significant (Z=-2.429, P<0.05). The serum albumin level in the observation group after the intervention was higher than that before intervention [(33.44±3.19) vs (30.90±3.34)g/L], and the difference was statistically significant (t=6.528, P < 0.01). The scores of SWAL-QOL in Chinese version of the two groups were higher than those before the intervention, and after the intervention, the score of observation group was higher than that of control group [135.0 (129.0,149.0) vs 103.0 (94.0,136.0) points], and the difference was statistically significant (Z=-3.023, P < 0.01). Conclusions Multidimensional rehabilitation management mode has a positive effect on ensuring the nutritional needs of patients with dysphagia after stroke, improving swallowing function and providing quality of life.

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雷茵,顾琳,严琳,徐涵,高怡,武军.多维度康复管理模式在卒中后吞咽障碍患者康复中的应用[J].神经疾病与精神卫生,2023,23(8):
DOI :10.3969/j. issn.1009-6574.2023.08.007.

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  • 在线发布日期: 2023-08-29