The Effect Of Care Bundles On The Prevention Of Aspiration Pneumonia In Patients With Ischemic Stroke

Objective To construct a scheme of care bundles for the prevention of aspiration pneumonia in ischaemic stroke patients by using the evidence-based methodology.To validate the clinical effectiveness of care bundles in preventing aspiration pneumonia in patients with ischaemic stroke by using the non-synchronous randomised controlled trial.Methods 1.Theoretical study: Based on the evidence-based methodology and the JBI model of evidence based healthcare,a top-down search of the literature was conducted based on the "6S" evidence pyramid model.And then,evaluating the quality of the literatures and the hierarchy of evidence and the level of recommendation were clarified.The initially constructed care bundles scheme was finalised after 3 rounds of Delphi to form a final scheme of care bundles for the prevention of aspiration pneumonia in patients with ischaemic stroke.2.Clinical practice study: The non-synchronous randomized controlled trial was used to select 64 patients with ischemic stroke hospitalized in the neurology department of a tertiary hospital from November 2021 to September 2022,and they were divided into a test group and a control group according to the randomized number table method,with 32 cases in each group;the test group was given the bundles of care and the control group was given conventional care,and the intervention period was 10 days.After the intervention,differences in the incidence of aspiration pneumonia,clinical symptoms(dysphagia,cough,sputum),various scores(AIS-APS score,GUSS screening score,MUST score,OHAT score)and blood inflammatory indicators were compared between the two groups.The data obtained were entered into Excel for collation and SPSS 26.0 was used for statistical analysis to verify the clinical effectiveness of care bundles in preventing aspiration pneumonia in patients with ischaemic stroke.Results 1.A scheme of care bundles for the prevention of aspiration pneumonia in patients with ischaemic stroke was constructed.A total of 29 pieces of evidence were included,including 23 pieces of Level A evidence and 6 pieces of Level B evidence.The scheme included 7 dimensions of organisation,risk screening,general care and condition monitoring,functional training,dietary guidance,medication prevention and health education,with a total of 25 entries.2.Before intervention: The differences in general information between the two groups of patients were not statistically significant and were comparable(P > 0.05).After the intervention:(1)The incidence of AP in the test group was lower than that in the control group,and the difference was statistically significant(P < 0.05).(2)The swallowing disorder and cough in the test group were better than those in the control group,and the difference was statistically significant(P<0.05),while there was no statistical difference in the comparison of coughing sputum(P>0.05).(3)The AIS-APS score in the test group was lower than that in the control group,and the difference was statistically significant(P<0.05),and there were more people with very low and low risk of AP in the test group than in the control group,and the difference was statistically significant(P<0.05).(4)The GUSS screening score in the test group was higher than that in the control group,and the difference was statistically significant(P<0.05),and the number of GUSS screening score≥15 in the test group was higher than that in the control group,and the difference was statistically significant(P<0.01).(5)The results of blood inflammatory indexes in the test group were all better than those in the control group,except for MLR(P>0.05),and the differences were statistically significant(P<0.05).(6)The MUST score of the test group was lower than that of the control group,and the difference was statistically significant(P<0.05).(7)The OHAT score in the test group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions 1.The constructed scheme of care bundles are scientific and extrapolative,facilitating the clinical translation of the latest and best evidence and providing some scientific basis for clinical care practice in the prevention of aspiration pneumonia in patients with ischemic stroke.2.The care bundles scheme reduced the incidence of aspiration pneumonia in ischemic stroke patients,improved the patients’ swallowing function,nutrition and oral status,optimized the blood inflammatory index test results,improved the quality of clinical care and enhanced nursing management.