ICU获得性吞咽障碍基于HACCP原则的康复方案的建立与应用

胡碎钗; 王丹进; 陈洁; 曹拂晓; 李霞; 颜雷雷

doi:10.16766/j.cnki.issn.1674-4152.002880

ICU获得性吞咽障碍基于HACCP原则的康复方案的建立与应用

doi: 10.16766/j.cnki.issn.1674-4152.002880

1.
温州医科大学附属第二医院重症监护室，浙江温州 325000
2.
温州医科大学附属第二医院康复科，浙江温州 325000
3.
温州医科大学附属第二医院急诊科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2020KY189

温州市科技局项目 Y20190347

详细信息

通讯作者:
胡碎钗, E-mail: hsc20220126@163.com

中图分类号: R473
计量
- 文章访问数: 160
- HTML全文浏览量: 29
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-11
- 网络出版日期: 2023-04-20

Establishment and application of a rehabilitation program based on the HACCP principles for ICU-acquired dysphagia

1.
Intensive Care Unit of the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨对重症监护病房(ICU)获得性吞咽障碍患者实施以危害分析和关键控制点(HACCP)原则为基础的康复方案的应用效果及安全性。方法回顾性分析2020年5月—2021年12月于温州医科大学附属第二医院治疗的142例ICU获得性吞咽障碍患者的临床资料。按照入院时间不同，分为对照组(2020年5月—2021年2月)与研究组(2021年3—12月)，各71例。对照组行常规康复训练，研究组行基于HACCP原则的康复训练。比较2组Gugging吞咽功能评估量表(GUSS)、洼田饮水试验(WST)、中文版吞咽生存质量量表(SWAL-QOL)及不良事件发生率。结果训练后，研究组GUSS评分为(19.14±0.43)分，明显高于对照组的(17.84±1.04)分，WST、进食时间、睡眠、食物选择、症状频率评分为(1.34±0.46)分、(51.37±4.29)分、(56.48±4.94)分、(61.22±5.02)分、(47.19±4.52)分，明显低于对照组的(1.98±0.81)分、(63.26±5.15)分、(65.25±5.63)分、(65.32±5.47)分、(53.53±4.16)分，差异有统计学意义(t=9.734、5.789、14.947、9.866、4.653、8.696，均P < 0.001)；研究组不良事件发生率为1.41%(1/71)，明显低于对照组的29.58%(21/71)，差异有统计学意义(χ²=21.515，P < 0.001)。结论 ICU获得性吞咽障碍基于HACCP原则的康复训练效果显著，且安全性较高。
- 获得性吞咽障碍 /
- 重症监护病房 /
- 危害分析和关键控制点 /
- 应用效果 /
- /
Abstract: Objective This study aimed to investigate the application effect and safety of a rehabilitation program based on the hazard analysis and critical control points (HACCP) principles for patients with acquired dysphagia in the intensive care unit (ICU). Methods The clinical data of 142 patients with ICU-acquired dysphagia treated in the Second Affiliated Hospital of Wenzhou Medical University from May 2020 to December 2021 were retrospectively analysed. Based on different admission time periods, they were divided into the control group (admission from May 2020 to February 2021) and research group (admission from March 2021 to December 2021), with 71 cases in each group. The control group received conventional rehabilitation training, and the research group received rehabilitation training based on HACCP principles. When leaving the ICU, the Gugging Swallowing Screen (GUSS) assessment scale, the water swallowing test (WST) score, Chinese version of the swallowing quality of life scale (SWAL-QOL) score and the incidence of adverse events (including aspiration, aspiration pneumonia and substandard diet) were compared between the two groups. Results After training, the GUSS score in the research group was 19.14±0.43, which was significantly higher than that in the control group (17.84±1.04), and the WST, feeding time, sleep, food choice and symptom frequency scores were 1.34±0.46, 51.37±4.29, 56.48±4.94, 61.22±5.02 and 47.19±4.52, respectively, which were significantly lower than the control group (1.98±0.81, 63.26±5.15, 65.25±5.63, 65.32±5.47 and 53.53±4.16). The difference was statistically significant (t=9.734, 5.789, 14.947, 9.866, 4.653, 8.696; all P < 0.001). The rate of adverse events occurred in the research group was 1.41%(1/71), which was significantly lower than 29.58%(21/71) in the control group, and the difference was statistically significant (χ²=21.515, P < 0.001). Conclusion Rehabilitation training based on the HACCP principle for ICU-acquired dysphagia has a significant effect and high safety.
- Acquired dysphagia /
- Intensive care unit /
- Hazard analysis and critical control points /
- Water swallowing test /
- GUSS swallowing screen assessment scale /
- Adverse events

HTML全文

表 1 2组吞咽障碍患者一般资料比较

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

组别	例数	性别(例)		年龄(x±s，岁)	气管插管留置时间(x±s，d)	吸烟/非吸烟(例)
组别	例数	男性	女性	年龄(x±s，岁)	气管插管留置时间(x±s，d)	吸烟/非吸烟(例)
对照组	71	45	26	57.14±9.18	10.96±2.16	32/39
研究组	71	43	28	57.71±9.05	10.48±2.11	35/36
统计量		0.120^a		0.373^b	1.340^b	0.254^a
P值		0.730		0.710	0.183	0.614
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组吞咽障碍患者训练前后GUSS评分与WST评分比较(x±s，分)

Table 2. Comparison of GUSS score and WST score between two groups of patients with swallowing disorders before and after training (x±s, points)

组别	例数	GUSS评分		WST评分
组别	例数	训练前	训练后	训练前	训练后
对照组	71	12.93±2.17	17.84±1.04^a	4.28±0.69	1.98±0.81^a
研究组	71	12.43±1.98	19.14±0.43^a	4.21±0.83	1.34±0.46^a
t值		1.434	9.734	0.547	5.789
P值		0.154	< 0.001	0.586	< 0.001
注：与同组训练前比较，^aP < 0.05。

下载: 导出CSV

表 3 2组吞咽障碍患者训练前后SWAL-QOL评分比较(x±s，分)

Table 3. Comparison of SWAL-QOL score between two groups of patients with swallowing disorders before and after training (x±s, points)

组别	例数	进食时间		睡眠		食物选择		症状频率
组别	例数	训练前	训练后	训练前	训练后	训练前	训练后	训练前	训练后
对照组	71	78.02±8.14	63.26±5.15^a	84.36±7.15	65.25±5.63^a	86.14±9.21	65.32±5.47^a	80.16±6.02	53.53±4.16
研究组	71	78.67±9.10	51.37±4.29^a	84.11±8.02	56.48±4.94^a	87.06±8.89	61.22±5.02^a	81.33±6.25	47.19±4.52
t值		0.449	14.947	0.196	9.866	0.606	4.653	1.136	8.696
P值		0.654	< 0.001	0.845	< 0.001	0.546	< 0.001	0.258	< 0.001
注：与同组训练前比较，^aP < 0.05。

下载: 导出CSV

表 4 2组吞咽障碍患者不良事件发生率比较[例(%)]

Table 4. Comparison of the incidence of adverse events in dysphagia patients between the two groups [cases (%)]

组别	例数	误吸	吸入性肺炎	饮食量不达标	合计
对照组	71	9(12.68)	7(9.86)	5(7.04)	21(29.58)
研究组	71	1(1.41)	0	0	1(1.41)
χ²值		6.885	7.363	5.182	21.515
P值		0.009	0.007	0.023	< 0.001

下载: 导出CSV

参考文献(19)

[1]	周萌, 梁涛. ICU获得性吞咽障碍的研究现状[J]. 护理研究, 2017, 31(3): 268-271. doi: 10.3969/j.issn.1009-6493.2017.03.005 ZHOU M, LIANG T. Research status quo of ICU patients with acquired dysphagia[J]. Chinese Nursing Research, 2017, 31(3): 268-271. doi: 10.3969/j.issn.1009-6493.2017.03.005
[2]	ZUERCHER P, MORET C S, DZIEWAS R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management[J]. Crit Care, 2019, 23(1): 103. doi: 10.1186/s13054-019-2400-2
[3]	马旭珏, 雷洪, 刘洁. ICU获得性吞咽障碍的研究进展[J]. 现代医药卫生, 2019, 35(18): 2852-2855. doi: 10.3969/j.issn.1009-5519.2019.18.027 MA X J, LEI H, LIU J. Research progress of ICU-acquired dysphagia[J]. Journal of Modern Medicine & Health, 2019, 35(18): 2852-2855. doi: 10.3969/j.issn.1009-5519.2019.18.027
[4]	ZUERCHER P, SCHENK N V, MORET C, et al. Risk factors for dysphagia in ICU patients after invasive mechanical ventilation[J]. Chest, 2020, 158(5): 1983-1991. doi: 10.1016/j.chest.2020.05.576
[5]	万娜, 张春艳, 王淑芹, 等. ICU获得性吞咽障碍恢复时间及影响因素分析[J]. 护理研究, 2021, 35(3): 546-549. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202103041.htm WAN N, ZHANG C Y, WANG S Q, et al. Analysis of recovery time of acquired dysphagia in ICU and its influencing factors[J]. Chinese Nursing Research, 2021, 35(3): 546-549. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202103041.htm
[6]	白珊珊. HACCP认证法在化疗药物配置职业防护安全管理中的应用[J]. 中医药管理杂志, 2019, 27(22): 125-126. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYG201922066.htm BAI S S. Application of HACCP certification in occupational safety management of chemotherapeutic drug allocation[J]. Journal of Traditional Chinese Medicine Management, 2019, 27(22): 125-126. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYG201922066.htm
[7]	阎蕾, 庄若, 徐芳, 等. 基于HACCP原理构建不良事件漏报屏障系统[J]. 全科护理, 2021, 19(30): 4276-4278. doi: 10.12104/j.issn.1674-4748.2021.30.027 YAN L, ZHUANG R, XU F, et al. Based on HACCP principle, adverse event missing report barrier system was constructed[J]. Chinese General Practice Nursing, 2021, 19(30): 4276-4278. doi: 10.12104/j.issn.1674-4748.2021.30.027
[8]	刘晓娜, 李华. 基于HACCP的四肢皮瓣移植术后康复护理效果观察[J]. 河北医药, 2020, 42(16): 2557-2560. doi: 10.3969/j.issn.1002-7386.2020.16.039 LIU X N, LI H. The effects of rehabilitation nursing after four limbs flap transplantation based on HACCP[J]. Hebei Medical Journal, 2020, 42(16): 2557-2560. doi: 10.3969/j.issn.1002-7386.2020.16.039
[9]	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)[J]. 中华物理医学与康复杂志, 2018, 40(1): 1-10. Expert Consensus Group on Rehabilitation Assessment and Treatment of dysphagia in China. Expert consensus on the evaluation and treatment of swallowing disorders in China (2017 edition)[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2018, 40(1): 1-10.
[10]	TRAPL M, ENDERLE P, NOWOTNY M, et al. Dysphagia bedside screening for acute-stroke patients: the gugging swallowing screen[J]. Stroke, 2007, 38(11): 2948-2952. doi: 10.1161/STROKEAHA.107.483933
[11]	大西幸子, 孙启良. 摄食-吞咽障碍康复实用技术[M]. 北京: 中国医药科技出版社, 2000: 165-166. DAXI XINGZI, SUN Q L. Practical techniques for rehabilitation of ingestion and swallowing disorders[M]. Beijing: China Medical Science and Technology Press, 2000: 165-166.
[12]	谭嘉升, 丘卫红, 刘中良, 等. 中文版吞咽生命质量量表信度和效度的研究[J]. 中华物理医学与康复杂志, 2016, 38(9): 669-673. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM201905005.htm TAN J S, QIU W H, LIU Z L, et al. The reliability and validity of the Chinese version of swallowing quality of life questionnaire[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2016, 38(9): 669-673. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM201905005.htm
[13]	戚春霞, 厉春林, 张雅芝, 等. 重症患者ICU获得性吞咽障碍影响因素的Meta分析[J]. 中华护理杂志, 2021, 56(8): 1236-1241. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202108026.htm QI C X, LI C L, ZHANG Y Z, et al. Dysphagia in the intensive care unit: a meta-analysis of risk factors[J]. Chinese Journal of Nursing, 2021, 56(8): 1236-1241. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202108026.htm
[14]	陈惠明. ICU获得性吞咽障碍患者吞咽功能训练方案的制定及应用[J]. 齐齐哈尔医学院学报, 2020, 41(10): 1314-1315. https://www.cnki.com.cn/Article/CJFDTOTAL-QQHB202010051.htm CHEN H M. Development and application of swallowing function training program for ICU patients with acquired dysphagia[J]. Journal of Qiqihar Medical University, 2020, 41(10): 1314-1315. https://www.cnki.com.cn/Article/CJFDTOTAL-QQHB202010051.htm
[15]	王兰珍, 徐利萍, 徐淑芬, 等. 循证视角下脑卒中吞咽障碍患者护理管理方案及效果评价[J]. 中华全科医学, 2021, 19(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.001848 WANG L Z, XU L P, XU S F, et al. Nursing management plan and effect evaluation of stroke patients with dysphagia from the evidence-based perspective[J]. Chinese Journal of General Practice, 2021, 19(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.001848
[16]	SCHEFOLD J C, WOLLERSHEIM T, GRUNOW J J, et al. Muscular weakness and muscle wasting in the critically ill[J]. J Cachexia Sarcopenia Muscle, 2020, 11(6): 1399-1412.
[17]	DUBIN R, VEITH J M, GRIPPI M A, et al. Functional outcomes, goals, and goal attainment amongst chronically critically ill long-term acute care hospital patients[J]. Ann Am Thorac Soc, 2021, 18(12): 2041-2048.
[18]	张翠翠, 唐一楠, 李靖, 等. 危害分析和关键控制点法在新药引进后门诊药房调剂差错风险管理中的应用[J]. 中国医院用药评价与分析, 2020, 20(6): 719-722. https://www.cnki.com.cn/Article/CJFDTOTAL-YYPF202006021.htm ZHANG C C, TANG Y N, LI J, et al. Application of hazard analysis and critical control point method in risk management of drug dispensing errors after introduction of new drugs in outpatient pharmacy[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2020, 20(6): 719-722. https://www.cnki.com.cn/Article/CJFDTOTAL-YYPF202006021.htm
[19]	王玉秀. 基于HACCP的精神科无抽搐电休克治疗患者SBAR护理交接查检表的设计和应用[J]. 中国实用护理杂志, 2018, 34(5): 378-382. WANG Y X. The design and application of SBAR nurses handover check list for Patients treated with modified electroconvulsive therapy based on HACCP[J]. Chinese Journal of Practical Nursing, 2018, 34(5): 378-382.