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重度创伤性脑损伤后吞咽困难患者的循证综合护理:一项随机对照试验

Evidence-based bundled care for patients with dysphagia after severe traumatic brain injury: a randomized controlled trial.

作者信息

Yan Na, Jiang Jinyue, Liu Huali, Deng Li, Hu Qiongfang, Sun Jiawei, Lv Meifen

机构信息

Department of Rehabilitation Medicine, Qujing No. 1 Hospital Qujing, Yunnan Province, China.

Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University Kunming, Yunnan Province, China.

出版信息

Am J Transl Res. 2021 Jul 15;13(7):7819-7828. eCollection 2021.

Abstract

OBJECTIVE

To explore the effect of an evidence-based bundled care model in patients with dysphagia after severe traumatic brain injury (TBI).

METHODS

This is a prospective randomized controlled study. A total of 60 patients with dysphagia after severe TBI (traumatic brain injury) admitted to the Department of Rehabilitation Medicine were selected and randomly divided into the test group (n=30) and the control group (n=30). Patients in the control group received routine care in the Department of Rehabilitation Medicine, while patients in the test group received evidence-based bundled care on the basis of the treatment of the control group. The improvement of swallowing function (dye test in comatose patients), oral hygiene, and nutritional risk was assessed in both groups. The incidence of adverse events such as aspiration and aspiration pneumonia, as well as the length and costs of hospitalization were compared between the two groups.

RESULTS

Compared with patients in the control group, swallowing function of patients in the test group was significantly improved after the care (P<0.05), and for comatose patients, the positive rate of Evans blue dye test was markedly reduced (P<0.05). Compared with patients in the control group, the oral hygiene of patients in the test group was significantly improved after care, and the nutritional risk scores were also significantly decreased (P<0.05). During hospitalization, the total incidence of adverse events, length and costs of hospitalization of patients in the test group were significantly lower than those in the control group (P<0.05).

CONCLUSION

Evidence-based bundled care can effectively improve swallowing function and reduce the incidence of nutritional risks and adverse events in patients with dysphagia after severe TBI, which further promotes postoperative rehabilitation of patients.

摘要

目的

探讨循证综合护理模式对重型颅脑损伤(TBI)后吞咽困难患者的影响。

方法

这是一项前瞻性随机对照研究。选取康复医学科收治的60例重型TBI后吞咽困难患者,随机分为试验组(n = 30)和对照组(n = 30)。对照组患者接受康复医学科常规护理,试验组患者在对照组治疗基础上接受循证综合护理。评估两组患者吞咽功能(昏迷患者染料试验)、口腔卫生及营养风险的改善情况。比较两组患者误吸及误吸性肺炎等不良事件的发生率、住院时间及住院费用。

结果

与对照组患者相比,试验组患者护理后吞咽功能明显改善(P < 0.05),昏迷患者伊文思蓝染料试验阳性率明显降低(P < 0.05)。与对照组患者相比,试验组患者护理后口腔卫生明显改善,营养风险评分也明显降低(P < 0.05)。住院期间,试验组患者不良事件总发生率、住院时间及住院费用均明显低于对照组(P < 0.05)。

结论

循证综合护理可有效改善重型TBI后吞咽困难患者的吞咽功能,降低营养风险及不良事件发生率,进一步促进患者术后康复。

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