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[目的]观察艾灸联合康复护理干预防治脑中风并发吞咽功能障碍疗效。[方法]使用随机平行对照方法,将60例住院患者按病志号抽签方法简单随机分为两组。对照组30例基础护理:指导及全程监护患者进食,误吸立即吸出,加强咳嗽动作训练,提高排除气管异物能力;餐前后口腔护理;吞咽训练:(1)空吞咽口水等;(2)手指捏紧下颚,做张口动作;多做张口、鼓腮、闭唇、吹气、闭眼、吸吮以及微笑等动作,让患者舌尖与舌体向口腔上部顶起用力舔舐上颚,并做伸舌卷舌等运功;(3)吞咽反射:长棉棒刺激腭弓、软腭、舌后部及咽后壁等。摄食训练:(1)半卧位或健侧卧位,食物便于集中健侧口腔;(2)由黏性半流食物→半固体食物→易咀嚼固体食物→流质,循序渐进,小量开始,逐步增加,进食速度宜慢不宜快。观察摄食情况、进食呛咳、进食时间,指导患者正确处理滞留在咽部食物,包括空吞咽、交互吞咽、侧方吞咽,去除滞留咽部食物残渣等。心理护理:与患者交流沟通,疏导疾病恐惧心理。治疗组30例艾灸:平躺或半卧位,颈部暴露,天突、廉泉温和灸或回旋灸,15~20min/穴,以皮肤红晕为度,同时双侧颈部按摩,10~15min/次,2次/d;基础护理同对照组。连续康复护理干预2周为1疗程。观测临床症状、吞咽功能、不良反应。康复护理干预1疗程(1周),判定疗效。[结果]治疗组优8例,良13例,中5例,可3例,差1例,优良率70.00%,对照组优5例,良7例,中10例,可5例,差3例,优良率40.00%,治疗组优于对照组(P<0.05)。[结论]艾灸联合康复护理干预防治脑中风并发吞咽功能障碍,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of moxibustion combined with rehabilitation nursing intervention on the prevention and treatment of stroke and swallowing dysfunction. [Methods] Using randomized parallel control method, 60 inpatients were randomly divided into two groups randomly according to the method of lot drawing. The control group of 30 cases of basic nursing: guidance and full monitoring of patients eating, aspiration immediately aspiration, to enhance cough movement training to improve the ability to exclude tracheal foreign body; oral care before and after; swallowing training: (1) swallowing swallowing empty; (2) fingers Pinch the lower jaw, doing mouth mouth action; do more mouth, drum gills, lips closed, inflatable, eyes closed, sucking and smiling and other actions, so that the patient’s tongue and tongue to the top of the oral cavity jacking forced licking the palate and tongue Curl and other exercises; (3) swallowing reflex: Long cotton swab to stimulate the palatal arch, soft palate, posterior tongue and pharyngeal wall and so on. Feeding training: (1) semi-recumbent or contralateral supine, food easy to focus on the contralateral oral cavity; (2) from the viscous semi-liquid food → semi-solid food → easy to chew solid food → liquid, step by step, small start, and gradually Increase, eating speed should not slow fast. Observation of food intake, eating cough, eating time, to guide patients to properly deal with stranded food in the pharynx, including empty swallowing, swallowing side, side swallowing, removal of residual pharyngeal food debris. Psychological care: communicate with patients to divert fear of disease. The treatment group of 30 cases of moxibustion: lying or semi-recumbent position, neck exposure, Tian protrusion, Lianquan mild moxibustion or gynecological moxibustion, 15 ~ 20min / point to the degree of skin flush, while bilateral neck massage, 15min / time, 2 times / d; basic nursing with the control group. Continuous rehabilitation nursing intervention for 2 weeks for a course of treatment. Observation of clinical symptoms, swallowing function, adverse reactions. Rehabilitation nursing intervention 1 course (1 week), to determine the efficacy. [Results] The results of the treatment group were excellent in 8 cases, good in 13 cases, fair in 5 cases, fair in 3 cases and poor in 1 case. The excellent and good rate was 70.00%. The control group had 5 cases excellent, 7 cases good, 10 cases fair, 5 cases fair and 3 poor For example, the excellent and good rate was 40.00%, the treatment group was better than the control group (P <0.05). [Conclusion] Moxibustion combined with rehabilitation nursing intervention can prevent and cure cerebral apoplexy complicated with swallowing dysfunction, with satisfactory curative effect and no serious adverse reactions, which deserves promotion.