脑卒中吞咽困难患者发生误吸的影响因素及护理措施

目的探讨脑卒中吞咽困难患者发生误吸的影响因素及护理措施。方法选择2018年2月—2019年11月医院就诊的140例脑卒中吞咽困难患者为研究对象,根据是否发生误吸将其分为病例组(n=60例)与无误吸的对照组(n=80例),并分别采取单因素与多因素分析影响误吸的可能因素。结果单因素分析显示,不同年龄、是否脑干及小脑病变、吞咽障碍评分、机械通气时长、进食体位依从性、是否使用鼻胃管、及时排痰、疾病认知度均会对脑卒中吞咽困难患者发生误吸风险产生一定影响(P<0.05);经多因素Logistic回归分析结果显示,年龄≥65岁(OR=5.248),脑干及小脑病变(OR=4.689),吞咽障碍评分>24分(OR=3.883),机械通气时长≥7 d(OR=2.954),低进食体位依从性(OR=3.143),鼻胃管应用(OR=3.427)是增加误吸风险的独立危险因素(P<0.05)。结论患者自身及护理过程中均存在影响脑卒中吞咽困难患者误吸的相关因素,临床工作中应针对上述独立高危因素,实施体位、进食、呼吸道护理,加强吞咽功能训练,减少误吸发生率。

Influencing factors of aspiration in patients with facial stroke and dysphagia and its nursing measures

Objective To explore the influencing factors of aspiration in patients with facial stroke and dysphagia and its nursing measures.Methods To select 140 cases of patients with stroke and dysphagia who were treated in the hospital from February 2018 to November 2019 as the study objects.According to whether aspiration occurred or not,they were divided into a case group(n=60 cases)and a control group without aspiration(n=80 cases),and single-factor and multi-factor analysis were adopted to analyze the possible factors that affected aspiration.Results Univariate analysis showed that the different ages,whether brainstem and cerebellar lesions,dysphagia scores,duration of mechanical ventilation,eating position compliance,whether to use nasogastric tube,timely sputum excretion,and awareness of disease all had a certain impact on risk of aspiration in patients with stroke dysphagia(P<0.05).Multivariate Logistic regression analysis showed that the age≥65 years old(OR=5.248),brainstem and cerebellar lesions(OR=4.689),dysphagia scores>24 points(OR=3.883),duration of mechanical ventilation≥7 d(OR=2.954),low eating position compliance(OR=3.143)and application of nasogastric tube(OR=3.427)were the independent risk factors that increased the risk of aspiration(P<0.05).Conclusion There were the related factors that affected aspiration in patients with stroke dysphagia in the patients themselves and during the nursing process.Clinical work should focus on the above independent high-risk factors,implement posture,eating,and respiratory tract care,strengthen swallowing function training,and reduce the incidence of aspiration.