链条式管理模式在预防缺血性脑卒中患者吸入性肺炎中的应用

彭华华; 王永盛; 汪德秀

doi:10.16766/j.cnki.issn.1674-4152.004282

链条式管理模式在预防缺血性脑卒中患者吸入性肺炎中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004282

1.
温州市中西医结合医院内分泌科，浙江温州 325000
2.
温州市中西医结合医院神经内科
3.
温州市中西医结合医院神经外科

基金项目:

浙江省中医药科技计划项目 2020ZB241

温州市基础性科研项目 Y20240251

详细信息

通讯作者:
王永盛，E-mail：wys19851120@163.com

中图分类号: R743.3 R563.1
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- 文章访问数: 12
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-26
- 网络出版日期: 2026-03-13

Application of chain management model for aspiration pneumonia prevention in post-ischemic stroke populations

1.
Department of Endocrinology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的吸入性肺炎(AP)是缺血性脑卒中(IS)患者的常见并发症，不仅会延长住院时间，还会增加死亡风险，其预防需要系统化的解决方案。链条式管理是一种系统化、连续性、多学科协作的管理模式，本研究旨在探讨链条式管理模式在预防IS患者发生AP方面的应用价值。方法选取2022年1月—2024年1月温州市中西医结合医院接诊的150例IS患者，采用随机数字表法分为观察组和基线组，各75例。基线组采用常规管理模式，观察组采用链条式管理模式。比较2组IS患者AP发生情况、缺血性脑卒中相关性肺炎(AIS-APS)评分、Gugging吞咽误吸筛查量表(GUSS)评分、营养不良筛查工具(MUST)评分、口腔健康评估工具(OHAT)评分及满意度。结果观察组AP发生率低于基线组[12.00%(9/75) vs. 32.00%(24/75)，χ²=8.741，P=0.003]。观察组AP严重程度低于基线组(P=0.018)。年龄≥65岁的IS患者AP发生率高于＜65岁的IS患者，随吞咽障碍严重程度升高，IS患者AP发生率呈升高趋势(P＜0.05)。干预后观察组AIS-APS、MUST、OHAT评分均低于基线组，GUSS评分高于基线组(P＜0.05)。观察组患者满意度均高于基线组[97.33%(73/75) vs. 85.33%(64/75)，χ²=6.822，P=0.009]。结论链条式管理模式应用于IS患者能降低AP发生率及其严重程度，且患者满意度较高。
- 缺血性脑卒中 /
- 吸入性肺炎 /
- 链条式管理模式 /
- 满意度
Abstract: Objective Aspiration pneumonia (AP) is a common complication in patients with ischemic stroke (IS), which not only prolongs hospital stays but also increases the risk of mortality. Its prevention necessitates a systematic solution. Chain management represents a systematic, continuous, and multidisciplinary collaborative management model. This study aims to explore the application value of the chain management model in preventing AP in IS patients. Methods A total of 150 patients with IS admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2022 and January 2024 were enrolled and randomly divided into an observation group and a baseline group using the random number table method, with 75 cases in each group. The baseline group received conventional management, while the observation group adopted a chain management model. The occurrence of AP, the score of ischemic stroke-associated pneumonia (AIS-APS), the score of the gugging swallowing screening scale (GUSS), the score of the malnutrition universal screening tool (MUST), the score of the oral health assessment tool (OHAT), and the satisfaction degree of the two groups of IS patients were compared. Results The incidence of AP in the observation group was lower than that in the baseline group [12.00% (9/75) vs. 32.00% (24/75), χ²=8.741, P=0.003]. The severity of AP in the observation group was also lower than that in the baseline group (P=0.018). The incidence of AP in IS patients aged ≥65 years was higher than that in IS patients aged < 65 years. Additionally, as the severity of dysphagia increased among IS patients, the incidence of AP exhibited an upward trend (P < 0.05). After the intervention, the observation group had significantly lower AIS-APS, MUST, and OHAT scores, along with a higher GUSS score compared to the baseline group (P < 0.05). Patient satisfaction was notably higher in the observation group than in the baseline group [97.33% (73/75) vs. 85.33% (64/75), χ²=6.822, P=0.009]. Conclusion The application of the chain management model in patients with IS can reduce the incidence and severity of AP, and has a high patient's satisfaction.
- Ischemic stroke /
- Aspiration pneumonia /
- Chain management mode /
- Satisfaction

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表 1 2组IS患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with IS

项目	观察组(n=75)	基线组(n=75)	统计量	P值
性别[例(%)]			0.427^a	0.514
男性	35(46.67)	39(52.00)
女性	40(53.33)	36(48.00)
年龄(x±s, 岁)	65.49±5.72	66.07±5.91	0.611^b	0.542
OCSP分型[例(%)]			0.665^a	0.881
腔隙性梗死	51(68.00)	54(72.00)
部分前循环梗死	13(17.33)	10(13.33)
完全前循环梗死	6(8.00)	7(9.33)
后循环梗死	5(6.67)	4(5.33)
吞咽障碍	22(29.33)	25(33.33)	0.279^a	0.597
NIHSS评分[M(P₂₅, P₇₅)，分]	11(8，15)	10(8，15)	0.426^c	0.578
GCS评分[M(P₂₅, P₇₅)，分]	14(12，15)	15(12，15)	0.502^c	0.497
注：OCSP为牛津郡社区卒中项目分型(Oxfordshire community stroke project classification)；^a为χ²值，^b为t值，^c为U值。

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表 2 2组IS患者AP发生率及严重程度比较[例(%)]

Table 2. Comparison of the incidence and severity of AP between the two groups of patients with IS [cases (%)]

组别	例数	AP发生	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ~Ⅴ级
观察组	75	9(12.00)	7(77.78)	1(11.11)	1(11.11)	0
基线组	75	24(32.00)	6(25.00)	9(37.50)	8(33.33)	1(11.11)
统计量		8.741^a	0.009^b
P值		0.003	0.018
注：^a为χ²值，^b为U值。

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表 3 不同特征IS患者AP发生率比较[例(%)]

Table 3. Comparison of the incidence of AP among different subgroups of patients with IS [cases (%)]

项目	例数	AP发生	统计量	P值
年龄			9.804^a	0.002
＜65岁	77	9(11.69)
≥65岁	73	24(32.88)
吞咽障碍严重程度			28.033^b	＜0.001
无	103	17(16.50)
轻度	16	4(25.00)
中度	20	6(30.00)
重度	11	6(54.55)
OCSP分型			3.261^a	0.353
腔隙性梗死	105	20(19.05)
部分前循环梗死	23	5(21.74)
完全前循环梗死	13	5(38.46)
后循环梗死	9	3(33.33)
注：^a为χ²值，^b为U值。

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表 4 2组IS患者AIS-APS、GUSS、MUST、OHAT评分比较(分)

Table 4. Comparison of AIS-APS, GUSS, MUST and OHAT scores between the two groups of patients with IS (scores)

组别	例数	AIS-APS(x±s)		GUSS[M(P₂₅, P₇₅)]		MUST[M(P₂₅, P₇₅)]		OHAT[M(P₂₅, P₇₅)]
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	75	15.39±3.21	11.83±2.16^b	17(11，20)	20(18，20)^b	1(0，2)	0(0，1)^b	8(5，10)	4(2，7)^b
基线组	75	15.63±3.02	13.11±2.32^b	18(10，20)	20(17，20)^b	1(0，2)	1(0，1)^b	8(6，10)	5(2，8)^b
统计量		0.472^a	18.396^c	-0.071^d	2.089^d	-0.107^d	-2.190^d	-0.156^d	-2.194^d
P值		0.638	＜0.001	0.933	0.037	0.914	0.029	0.638	0.027
注：^a为t值，^c为F值，^d为Z值；与同组治疗前比较，^bP＜0.05。

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表 5 2组IS患者满意度比较[例(%)]

Table 5. Comparison of satisfaction between the two groups of patients with IS [cases (%)]

组别	例数	非常满意	满意	一般	不满意	总满意度
观察组	75	30(40.00)	43(57.33)	2(2.67)	0	73(97.33)
基线组	75	20(26.67)	44(58.67)	9(12.00)	2(2.67)	64(85.33)
统计量		2.148^a				6.822^b
P值		0.032				0.009
注：^a为U值，^b为χ²值。

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