摘要目的 观察基于国际功能、残疾和健康分类(ICF)的护理干预措施对脑卒中吞咽障碍患者的影响.方法 选择西安交通大学第二附属医院康复医学科脑卒中吞咽障碍患者共60例,按随机数字表法分为对照组和干预组各30例,2组均进行常规的摄食直接训练、口腔护理、薄荷脑冰棒刺激、球囊扩张治疗、吞咽电刺激、吞咽基础训练和健康知识宣教.干预组在常规护理的同时并在董艺提炼的34条吞咽障碍ICF核心项目上给予评估和护理干预,干预前、干预4周和8周时,采用洼田饮水试验进行等级评定,行表面肌电图(sEMG)检查获取咬肌、口轮匝肌、颏下肌群和舌骨下肌群的吞咽时程和最大振幅并进行比较.结果 对照组和干预组患者干预前、干预4周、干预8周洼田饮水试验分级分别为(4.12±0.23)、(3.34±0.57)、(2.76±0.46)分和(4.29±0.25)、(2.82±0.39)、(1.81±0.41)分,组内比较差异有统计学意义(F=67.19、368.56,P<0.01);干预4周和8周2组比较差异有统计学意义(t=4.81、7.22,P<0.01).对照组干预前、干预4周、干预8周咬肌、口轮匝肌、颏下肌群、舌骨下肌群吞咽时程组内比较差异有统计学意义(F=18.40~34.65,均P<0.01);干预组干预前、干预4周、干预8周咬肌、口轮匝肌、颏下肌群、舌骨下肌群吞咽时程组内比较差异有统计学意义(F=127.82~174.93,均P<0.01);干预4周和8周咬肌、口轮匝肌、颏下肌群、舌骨下肌群吞咽时程2组比较差异有统计学意义(t=-5.32~10.14,均P<0.01).对照组咬肌、口轮匝肌、颏下肌群、舌骨下肌群最大振幅干预前、干预4周、干预8周组内比较差异有统计学意义(F=28.11~90.54,均P<0.01);干预组咬肌、口轮匝肌、颏下肌群、舌骨下肌群最大振幅干预前、干预4周、干预8周组内比较差异有统计学意义(F=60.91~178.31,均P<0.01);干预4周和8周2组比较差异有统计学意义(t=-8.82~-4.06,P<0.01).结论 基于ICF的护理干预措施对脑卒中吞咽障碍患者有明显的效果.

abstractsObjective To observe the influence of nursing intervention based on International Classification of Functioning, Disability and Health (ICF) in the course of dysphagia for stroke patients. Methods A total of 60 stroke patients were chosen with dysphagia in the Second Affiliated Hospital of Xi'an Jiaotong University for the study.These patients were randomly divided into the control group and the intervention group with 30 cases in each group,two groups were directly treated with routine training, oral care, menthol popsicle stimulation, balloon dilatation treatment, swallowing electrical stimulation, basic training of swallowing and health education. The intervention group was assessed and intervened based on 34-item dysphagia ICF core project which Dongyi refined in addition to conventinal nursing.The grade was measured by the Kubota Toshio's drinking test,and the Surface Electromyography(sEMG)was performed to compare the swallowing duration and maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks. Results The average grade in Kubota Toshio′s drinking test before intervention,after 4 weeks and after 8 weeks in the control group and the intervention group were 4.12±0.23,3.34±0.57,2.76±0.46 and 4.29± 0.25,2.82 ± 0.39,1.81 ± 0.41, intra group comparison was statistically significant (F=67.19, 368.56, P<0.01).Comparison between two groups in 4 weeks,8 weeks after intervention was statistically significant (t=4.81, 7.22,P<0.01). In the control group, intra group comparison of swallowing duration in the masseter,the orbicularis oris,submental,and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=18.40-34.65,P<0.01).In the intervention group,intra group comparison of swallowing duration in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=127.82-174.93, P<0.01). There were significant differences in swallowing duration in the masseter, the orbicularis oris,submental,and the lower hyoid muscles in 4 weeks,8 weeks after intervention between the two groups(t=-5.32-10.14,P<0.01).In the control group,intra group comparison of maximum amplitude in the masseter,the orbicularis oris,submental,and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=28.11-90.54,P<0.01).In the intervention group,intra group comparison of the maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=60.91-178.31,P<0.01).There were significant differences in the maximum amplitude in 4 weeks,8 weeks after intervention between the two groups(t=-8.82--4.06,P<0.01). Conclusions Nursing intervention based on ICF has obvious curative effect on stroke patients with dysphagia.