急性脑卒中留置胃管患者拔除胃管的评估方法及时机的研究

目的 探讨急性脑卒中留置胃管患者拔除胃管最佳评估方法及时机.方法 将2009年10月至2011年10月收治的312例脑卒中伴吞咽功能障碍的患者,随机分为2组,对照组156例,采取遵医嘱拔除胃管的方法,试验组156例,护理人员采用床边吞水测试(Bed-side Water Swallowing Test)[1]对留置胃管1周的患者进行吞咽评估,再确定患者是否可以拔除胃管,比较2组患者拔除胃管时间、再次置管率、呼吸道感染、误吸、胃肠道感染、上消化道出血发生率及主要营养指标.结果 实验组与对照组比较,前者留置胃管时间明显缩短、再次置管率明显降低、呼吸道感染胃肠道感染、上消化道出血发生率明显低于后者,留置胃管后主要营养的指标明显高于后者,两者比较差异有显著性(P＜0.05).结论 通过使用床边吞咽水试验对脑卒中留置胃管的患者进行吞咽评估,确定患者拔除胃管的时机,可以降低并发症的发生,缩短患者留置胃管的时间,增加患者由口进食的机会,增强对患者的营养供给,提高了护士对病人护理的主动性.

The exploration of the optimal evaluation method and extraction time of acute stroke patients with indwelling gastric tube

Objective To explore the optimal evaluation method and extraction time of acute stroke patients with indwelling gastric tube. Methods From October 2009 to October 2011,300 cases of stroke patients with swallowing dysfunction, were randomly divided into 2 groups. The control group of 156 cases took the proscribed extraction method, while nursing staff took bedside water swallowing test（Bed-side Water Swallowing Test） for a week to 156 patients with indwelling gastric tube for swallowing assessment in the test group, to determine whether to extract. The extraction time, once again placing tube rate, respiratory tract infections, aspiration, gastrointestinal infections, upper digestive tract hemorrhage and main nutritional index of 2 groups were compared. Results Compared to control group, gastric tube indwelling time of test group was obviously shortened, again catheterization rate was significantly lower in infection of the respiratory tract, gastrointestinal infections, upper digestive tract hemorrhage were lower, indwelling gastric tube main nutrition index was higher, with significant differences（P〈 0.05）. Conclu- sions The swallowing assessment in stroke patients with indwelling gastric tube through bedside swallowing water test to identify extraction time, can reduce the incidence of complications, shorten the indwelling gastric tube time, increase oral feeding opportunities, enhance nutrition supply, and improve the nurses＇ enthusiasm.