目的 探讨神经外科NICU吞咽困难患者发生误吸的风险因素及护理措施.方法 选择2019年1月~2023年6月期间,泰兴市人民医院神经外科NICU吞咽困难患者132例为研究对象,对所有患者采用才藤氏吞咽障碍7级评价法进行误吸风险等级评估,根据其风险等级分为观察组(Ⅰ~Ⅲ级,n=62例)和对照组(4~Ⅵ级,n=70例),并对主要观察数据采用单因素和多因素Logistic回归分析,获取影响误吸发生的可能风险因素.结果 单因素分析提示,Ⅱ-Ⅲ级疾病程度的患者占比、GCS评分、是否存在吞咽中枢受损、是否建立人工气道、人工气道留置时长≥7天、吞咽功能评分≥24分、进食体位的依从性评分、可进食物稠度最高分级及合并心动过速、合并败血症等情况均对神经外科NICU吞咽困难患者发生误吸产生较大影响,观察组患者上述指标与对照组比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析提示,吞咽中枢受损(OR=1.213)、吞咽功能评分≥24分(OR=1.030)、人工气道留置时间≥7天(OR=2.093)、合并心动过速(OR=7.547)是增加神经外科NICU吞咽困难患者发生误吸的独立风险因素.结论 神经外科NICU吞咽困难患者存在吞咽中枢受损、吞咽功能评分≥24分、人工气道留置时间≥7天及合并心动过速等是其发生误吸的独立风险因素.护理人员在护理过程中,对有独立高危因素的重点人群应加强护理管理,规范护理操作,以减少其误吸的发生率.
Objective To investigate the risk factors and nursing measures of aspiration in patients with dysphagia in neurosurgical NICU.Methods From January 2019 to June 2023,132 patients with dysphagia in the NICU of the Neurosurgery Department of Taixing People's Hospital were selected as the research subjects.All patients were evaluated for aspiration risk using Saito's 7-level evaluation method for dysphagia.The grades were divided into observation group(Grades Ⅰto Ⅲ,n=62 cases)and control group(Grades Ⅳ to Ⅵ,n=70 cases).Single-fac-tor and multi-factor Logistic regression analysis were used to analyze the main observation data to obtain possible risk factors that affect the occurrence of aspiration.Results Univariate analysis showed that the proportion of pa-tients with grade Ⅱ-Ⅲ disease,GCS score,whether the swallowing center was impaired,whether the establish-ment of artificial airway,the artificial airway was retained for 7 days,the swallowing function score was 24 points,compliance score of feeding position,the highest grade of accessible food consistency,tachycardia,and sepsis all have a greater impact on aspiration in patients with dysphagia in the neurosurgery NICU,the difference was sig-nificant(P<0.05);multifactor Logistic regression analysis showed that damage to the swallowing center was(OR=1.213),the swallowing function score was 24 points(OR=1.030),the artificial airway was retained for 7 days(OR=2.093),and tachycardia(OR=7.547)were independent risk factors for aspiration in patients with dys-phagia in neurosurgical NICU.Conclusion The dysphagia patients in NICU of neurosurgery department have the following independent risk factors:impaired swallowing center,the swallowing function score was 24 points,the artificial airway retention time was 7 days and tachycardia.In order to reduce the incidence of aspiration,nursing staff should strengthen the nursing management and standardize the nursing operation for the key popula-tion with independent high risk factors in the nursing process.