| Objective:To construct the screening process of dysphagia and feeding training management process after acute stroke,and apply it to patients with dysphagia after acute stroke,so as to provide a reference for standardizing dysphagia screening and feeding management after acute stroke。Methods:1.Literature review and induction method were used to initially formulate the system levels and items of dysphagia screening and feeding training management process after acute stroke.2.Delphi method was used to organize expert consultation,determine the system levels and items of dysphagia screening and feeding training management process after acute stroke,and complete the construction of dysphagia screening and feeding training management process after acute stroke.3.A experimental study method was used.According to the inclusion and exclusion criteria,84 patients with acute stroke with dysphagia who were hospitalized in the Department of Neurosurgery of a ClassⅢGrade A hospital from November2021 to June 2022 were selected.They were randomly divided into control group and experimental group,with 42 patients in each group.The control group received routine nursing methods such as posture and diet guidance,nasal feeding tube nursing,oral nursing,condition observation(swallowing screening and functional exercise),while the experimental group received nursing according to swallowing screening and feeding training management process.The contents included screening timing,screening content and scale,adjustment of eating position,swallowing sensation promotion,swallowing assistance training,quantification of food traits and bite size by Volume-Viscosity Swallowing Test,oral cleaning,eating monitoring,risk prevention,lung management,etc.The intervention was performed twice a day,30-60min each time,for 21 days.4.The statistical software SPSS 26.0 was used for data entry and statistical analysis.The measurement data in the two groups of data were analyzed by t-test and represented by the mean±standard deviation.Categorical variables were compared by Pearson’s X~2test or Fisher’s exact test.Rank sum test was used to compare grade data,and P<0.05 was considered statistically significant.Results:1.Through literature review,analysis and induction,the system levels and items of dysphagia screening and feeding training management process after acute stroke were initially formulated,including 10 first-level indicators and 27 second-level indicators.2.After two rounds of expert consultation,a set of screening and feeding training management procedures for dysphagia after acute stroke consisting of 11first-level indicators and 22 second-level indicators were determined.The results of two rounds of expert consultation are as follows:in the first round,the enthusiasm coefficient of experts is 75%,and the authority degree is 0.902;in the second round,the enthusiasm coefficient of experts was 100%,and the authority degree was 0.950.The coefficient of variation(CV)was 0.184-0.240,and the Kendall coefficient was0.206-0.460.The results of the two rounds of consultation showed significant difference by Kendall system test(P<0.05).3.Comparison of clinical effects between experimental group and control group showed:3.1 Comparison of baseline data:There was no significant difference in gender,age,education level,main caregiver,medical payment method,type of stroke,course of disease,treatment method,GCS score,Repeated Saliva Swallowing Test,and Water Swallowing Test between the two groups(P>0.05).3.2 Comparison of swallowing function before and after intervention:There was no significant difference in the swallowing function grades between the two groups before intervention(P>0.05),which was comparable.After intervention,the total effective rate of swallowing function recovery in the experimental group was90.47%(38/42)higher than that in the control group 64.29%(27/42),and the difference was statistically significant(P<0.05).3.3 Comparison of gastric tube removal rate:After intervention,the gastric tube removal rate of the experimental group was 69.05%(29/42),which was higher than that of the control group 45.24%(19/42),and the difference was statistically significant(P<0.05).3.4 Comparison of the incidence of aspiration pneumonia:After 21 days of intervention,the incidence of aspiration pneumonia in the experimental group was4.76%(2/42),which was lower than 11.90%(5/42)in the control group,but the difference was not statistically significant(P>0.05).3.5 Comparison of nutritional status:Before intervention,there were no significant differences in ALB,HB,BMI and TP between two groups(P>0.05).After intervention,HB,ALB and TP of the experimental group(125.57±6.25,39.93±3.32,71.93±2.52)were significantly better than those of the control group(121.17±5.68,36.90±3.62,70.33±2.39)(P<0.05).However,there was no significant difference in BMI score between the experimental group(22.87±1.57)and the control group(23.31±1.76)after intervention(P>0.05).Conclusion:1.In this study,the screening and feeding training management process of dysphagia after acute cerebral pawn constructed by literature review and Delphi expert consultation includes 11 first-level indicators and 22 second-level indicators,and the enthusiasm and authority of experts are both high,which is scientific and reliable.2.Through the experimental study to validate the feasibility and application effects of the process,the experimental group compared with control group,swallowing function,indwelling gastric tube pulling rate,the indicators such as nutritional status were significantly improved.It indicates that building management process can effectively improve the patients’swallowing function and prevent the occurrence of adverse outcome,and It is worthy of clinical promotion and application. |
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