脑卒中患者吞咽障碍筛查工具的研究进展

目的 系统检索脑卒中患者吞咽障碍筛查工具的相关研究,为临床护理人员更好地理解和应用吞咽障碍筛查工具提供参考依据.方法 采用范围综述的研究方法,以脑卒中、吞咽障碍、筛查工具等为关键词,检索PubMed、Web of Knowledge、CBM、中国知网、万方数据资源系统2017年7月20日前相关文献.提取纳入文献基本信息、吞咽障碍筛查工具的特征等数据.结果 共纳入13篇文献,从中提取了9个适用于脑卒中患者的吞咽障碍筛查工具,通过整合和分析,呈现了筛查工具的应用范围、条目内涵、筛查方法和测量学特性.结论 脑卒中患者吞咽障碍的筛查工具很多,目前尚无统一标准,仍需高质量研究进一步探讨.在临床实践中,护理人员可结合患者的病情及吞咽障碍相关症状与体征,按需选择合适的筛查工具.     

我国脑卒中误吸研究的文献计量学分析

[目的]分析我国脑卒中误吸相关研究现状,梳理研究热点,为进一步研究脑卒中误吸提供方向和参考。[方法]检索万方、知网、维普和中国生物医学文献医学网数据库,提取从建库至2017年5月与脑卒中误吸研究相关的文献,应用文献计量学方法进行分析。[结果]共检索到有效文献152篇,发文量总体上呈逐年增多趋势;文献主要来源于江苏省、广东省和河南省,且文献成果均来自于医院;基金论文占18.42%;研究内容主要集中在护理干预对预防误吸的应用效果以及脑卒中鼻饲病人的鼻饲管长度、进食体位和食物形态的研究方面。[结论]近年来临床对脑卒中误吸日渐重视,但研究质量仍有待进一步提高,缺乏深度和广度。建议在今后的研究中,重视脑卒中误吸筛查量表和相关因素的研究,强化循证理念和知识,加大对误吸护理措施规范化的研究,进而为制定脑卒中误吸相关指南提供研究依据。     

脑卒中后误吸筛查工具的研究进展

对国内外脑卒中后误吸的相关因素和筛查量表进行综述,指出目前脑卒中后误吸筛查工具标准尚未统一,量表内容存在差异,除标准吞咽功能量表(SSA)和洼田饮水试验在我国较为常用外,其余工具推广性均不佳。在今后的研究中,我国研究者不仅应致力于国外相关误吸筛查工具的翻译和修订,还应该加大对相关误吸筛查量表的临床实践,从而探索出适合我国病人的脑卒中后误吸筛查工具。     

脑卒中后吞咽障碍患者误吸的临床研究进展

误吸是脑卒中后吞咽障碍患者的常见并发症,早期识别误吸并给予积极干预,可有效降低脑卒中后吞咽障碍患者肺部感染及营养不良等并发症的发生率,缩短病程,减轻患者家庭及社会负担,提高患者生活质量。诱发误吸的因素多样,目前已有许多工具被开发用于识别误吸高危患者,但临床对于误吸筛查及评估的标准尚未达成共识。本文简要综述了脑卒中后吞咽障碍患者误吸机制、危险因素、筛查评估、风险管理等相关研究的进展,以期为早期识别脑卒中后吞咽障碍患者误吸及风险管控提供参考。     

中文版高血压患者服药依从性量表测量学特性的系统评价

目的 系统评价中文版高血压患者服药依从性量表的测量学特性及研究的方法学质量,为医护人员选择高质量的量表提供循证依据。方法 系统检索PubMed、Embase、Web of Science、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中与高血压患者服药依从性量表测量学特性评价相关的研究,检索时限为建库至2022年2月3日。按照健康测量工具遴选标准（consensus-based standards for the selection of health measurement instruments,COSMIN）要求,由2名研究者独立进行文献筛选和资料提取,采用COSMIN偏倚风险清单及质量标准评定量表测量学特性并形成最终推荐意见。结果 共纳入10项研究,涉及9个中文版高血压患者服药依从性量表,均未报告跨文化效度、测量误差、假设检验、反应度。因内容效度均为不充分或不确定,证据质量为中等或以下,最终9个量表均为B级推荐。结论 与其他8个量表相比,服药依从性自我效能量表修订版的测量学特性评价最为均衡,具有较好的信效度,但该量表的其他测量学特性仍有待验证。     

脑卒中后患者吞咽困难研究进展

目的对脑卒中后患者吞咽困难的评估、治疗、护理进行阐述。方法系统检索国内外关于脑卒中后吞咽困难相关筛查工具、评估内容、干预措施的相关文献,进行阐述和总结。结果通过归纳相关筛查吞咽困难的工具,临床上由相关有资质人员进行评估,及早发现吞咽困难,运用相关干预措施,为临床患者减少相关并发症的发生,改善脑卒中后患者吞咽困难的结局。结论通过相关知识规范并减少临床脑卒中后患者吞咽困难的结局,从而最大限度减少脑卒中后患者的并发症的发生,最终改善患者的临床结局。     

标准吞咽功能评估在卒中后误吸筛查中的应用价值

目的 探讨标准吞咽功能评估(SSA)在卒中后误吸筛查中的应用价值.方法 对81例急性脑卒中患者进行SSA筛查和纤维鼻咽喉镜吞咽功能检查(FEES).以FEES检查为金标准,计算SSA对急性脑卒中患者误吸诊断的灵敏度、特异度、阳性预测值和阴性预测值.对比SSA筛查阳性患者和SSA筛查阴性患者的肺炎发生率.结果 SSA对卒中后误吸诊断的灵敏度为95.0%,特异度53.7%,阳性预测值66.7%,阴性预测值91.7%.SSA筛查阳性患者的肺炎发生率高于SSA阴性患者(P＜0.05).结论 SSA在卒中后误吸的评估中是一个有价值的筛查工具.     

脑卒中患者误吸风险评估的研究进展

综述了脑卒中患者误吸风险评估的研究进展,主要包括误吸的相关危险因素、影像学辅助检查方法、床旁检查评估。认为选择合适的床边误吸风险评估的工具,及时、准确地发现脑卒中患者存在误吸风险,指导护士提早进行护理干预,对减少和避免脑卒中患者发生误吸具有重要的临床意义。     

老年脑卒中患者早期误吸风险评估筛查及预防策略的研究进展

本文归纳老年脑卒中患者误吸的相关概念,阐述了误吸的风险因素及评估工具,在此基础上,对老年脑卒中患者误吸预防策略进行整理综述,旨在为临床老年脑卒中患者预防误吸的护理提供一定的参考.     

脑卒中患者赋能护理干预的范围综述

目的 对脑卒中患者健康管理中的赋能护理干预研究进行范围审查,归纳和总结促进脑卒中患者健康管理的方案,为临床实践及未来该领域研究提供参考。方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Scopus、ProQuest等数据库中的脑卒中患者健康管理相关的赋能护理干预研究。检索时限为建库至2023年1月。对纳入的文献进行整合性分析。结果 纳入23篇文献,干预形式主要为线上或线下的一对一和团体干预;干预要素包括护患共同参与、提供信息和技能指导、心理支持、同伴支持4个主题;结局指标主要为患者的生活活动和自理能力、自我效能等。结论 赋能护理干预对脑卒中患者健康管理具有积极影响。未来研究需进一步延伸赋能护理干预的应用、丰富干预内容及形式、制订规范的评价标准,根据干预内容积极组建多学科干预小组,纳入领域专业人员以探求脑卒中患者健康管理的最佳赋能护理干预方案。     

Outcome assessment in randomized controlled trials of stroke rehabilitation

The lack of a unified approach to outcome assessment in stroke rehabilitation limits our ability to interpret evidence provided by randomized controlled trials (RCTs). The purpose of this review was to identify outcomes and assessment tools reported in RCTs of stroke rehabilitation interventions as a first step toward consistent assessment of outcomes. Given that the validity of research is linked to reliability and validity of measurement, the relationship between the use of previously developed outcome measures and the methodological quality of RCTs was explored.Electronic literature searches identified RCTs examining stroke rehabilitation therapies from 1968 to 2005. The Physiotherapy Evidence Database (PEDro) scale was used to assess methodological quality. Cited outcomes were recorded and assessment tools identified as previously published or study specific. Four hundred ninety-one RCTs cited the assessment of 1447 outcomes using 489 measurement tools. Two hundred fifty-four of these were previously published, and 235 were study specific. A core of 30 frequently cited tools was identified. The use of previously published assessment tools to evaluate primary study outcomes was associated with higher PEDro scores.Significant heterogeneity in outcome assessment was demonstrated, although a core of 30 frequently cited tools could be identified. Appropriate evaluation and selection of outcome measures would enhance the methodological quality of randomized controlled trials.     

临床实践项目持续性评估工具的范围综述

目的 全面收集国内外用于评估项目持续性的工具,比较其内涵、开发过程、特点以及应用情况,为临床医护人员持续开展循证护理实践选择持续性评估工具,促进循证临床实践项目科学、有效地持续性开展提供参考。 方法 计算机检索 PubMed、Web of Science、EMbase、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,查找用于评估项目实践持续性的工具,检索时限为从建库至2020年12月。提取各工具的条目数、信效度、评分方法、特点及适用范围等信息,对其进行描述。 结果 最终纳入7个持续性评估工具,共18篇全文文献,10篇关于评估工具的开发,8篇关于评估工具的运用。 结论 护理人员应根据我国国情与目前的医疗卫生资源来选择恰当的持续性评估工具,以促进基于最佳证据的循证实践项目持续进行,给患者带来最佳的临床结局。     

癌症生存者家庭适应相关测量工具的研究进展

介绍家庭适应的相关概念及起源,阐述家庭适应方面常用测量工具的发展历程、内容结构、适用人群、评分方法、信度与效度、应用现状等情况,以期能够指导临床工作者在实践过程中选择合适的家庭适应测量工具,旨在帮助研究者进一步开发适用于我国癌症生存者的特异性家庭适应测量工具。     

急性脑卒中患者预防误吸的护理管理

目的探讨预防急性脑卒中患者误吸的护理管理方法及效果。方法将470例患者分为实验组(288例)和对照组(182例),对照组按常规护理,实验组在此基础上进行吞咽障碍筛查及相应的摄食护理。结果实验组患者吞咽障碍检出率高于对照组(P<0.05);吞咽障碍患者中实验组经口及经胃管摄食吸入性肺炎发生率均低于对照组(P<0.01或P<0.05)。结论对急性脑卒中患者实施预防误吸护理可降低吸入性肺炎的发生率,促进患者的预后。     

卒中中心护士胜任力自评量表的研制和信效度检验

目的 编制卒中中心护士胜任力自评量表,为评估卒中中心护士的胜任力水平提供测量工具.方法 以胜任力理论为指导,通过文献分析、半结构式访谈及概念界定形成卒中中心护士胜任力自评量表的条目池,经2轮德尔菲专家咨询后形成量表初稿,通过预调查和正式调查进行量表的项目分析及信效度检验.结果 卒中中心护士胜任力自评量表包括理论知识、操...     

脑卒中患者护理质量控制系统的构建及应用研究

目的 建立系统、科学、适用于临床的脑卒中患者护理质量敏感性指标,基于指标构建和应用脑卒中患者护理质量控制系统。方法 借鉴美国国家护理质量数据库敏感性指标开发过程,系统检索Pubmed、Embase、CINAHL、中国知网、万方数据库及国内外护理质量敏感性指标网站,经过严格筛选和文献评价,初步构建脑卒中患者护理质量敏感性指标,运用专家会议法确定脑卒中患者护理质量敏感性指标。根据脑卒中患者护理质量敏感性指标、预试验结果,制订脑卒中患者护理质量病例报告单,依托中国脑卒中中心联盟构建脑卒中患者护理质量控制系统。中国9所医院使用此系统,进行脑卒中患者护理质量敏感性指标的数据填报。结果 通过文献检索,初步纳入83项脑卒中患者护理质量敏感性指标。通过专家会议法,最终纳入11项护理质量敏感性指标,包括美国国立卫生研究院脑卒中量表评估率、吞咽功能评估率、深静脉血栓预防率、吸入性肺炎预防率、入院48 h营养风险筛查率、良肢位摆放率、早期活动率、健康宣教实施率、压力性损伤发生率、泌尿系统感染发生率、脑卒中后抑郁发生率。构建脑卒中患者护理质量病例报告单时,全国17所医院根据脑卒中患者护理质量敏感性指标,填报完成298份病例报告单。全国9所医院在脑卒中患者护理质量控制系统中填报1 827份脑卒中患者护理质量敏感性指标数据。11项脑卒中患者护理质量敏感性指标中,实施率最高的前2项为健康宣教实施率（97.3%）和良肢位摆放率（96.5%）。结论 该研究构建的脑卒中患者护理质量敏感性指标可操作性强,可以指导脑卒中护理实践;脑卒中患者护理质量控制系统实用性强,能够收集、分析、反馈中国脑卒中患者护理质量敏感性指标的实施情况,促进脑卒中患者护理质量持续改进。     

Detection of eating difficulties after stroke: a systematic review

BACKGROUND: It is highly important in nursing care for persons with stroke to screen for, assess and manage eating difficulties. The impact on eating after stroke can be of different types, comprising dysphagia as well as eating difficulties in a larger perspective. Eating difficulties can cause complications such as malnutrition, dehydration, aspiration, suffocation, pneumonia and death. There is a lack of systematic reviews about methods to be used by nurses in their screening for eating difficulties. AIM: This review aims at systematically capturing and evaluating current peer-reviewed published literature about non-instrumental (besides pulse oximetry) and non-invasive screening methods for bedside detection of eating difficulties among persons with stroke. METHODS: A search was performed in Medline and 234 articles were obtained. After a selection process 17 articles remained, covering seven screening methods and including about 2,000 patients. CONCLUSION: Best nursing practice for detecting eating difficulties includes as the first step the Standardized Bedside Swallowing Assessment (SSA) to detect dysphagia (strong evidence). As the second step an observation should be made of eating including ingestion, deglutition and energy (moderate evidence). Applying pulse oximetry simultaneously to SSA can possibly add to the accuracy of aspiration detection, especially silent aspiration (limited evidence). The methods should be used as a complement to interviews.     

Endovascular therapy of stroke

Standard therapy of acute ischaemic stroke during the first three hours after symptom onset is intravenous thrombolysis. When contraindications exist, an endovascular approach might be possible. Intraarterial administration of thrombolytic drugs is the most common way. Additionally, there is an increasing use of mechanical tools that are expected to be faster and more effective. Three principles of mechanical thrombolysis are known: aspiration, extraction and fracturing of the thrombus. Different tools were tested clinically and some demonstrated its high efficiency. Larger studies are needed to compare those tools. Apart from recanalization of a cerebral vessel occlusion implantation of a stent might be necessary for prophylaxis of recurrent stroke.     

Optimal scoring methods of hand-strength tests in patients with stroke

The purpose of this study was to determine the optimal scoring methods for measuring strength of the more-affected hand in patients with stroke by examining the effect of reducing measurement errors. Three hand-strength tests of grip, palmar pinch, and lateral pinch were administered at two sessions in 56 patients with stroke. Five scoring methods were used to present the strength scores. The smallest real difference was used to provide information on the measurement error. The smallest real difference percentage was used to compare the effect on minimizing the error. Using mean score of tests for nonspastic patients carried out at least twice was found to be advisable to minimize measurement errors in the grip, palmar pinch, and lateral pinch tests. However, the use of hand-strength tests for patients with spasticity is limited because of the relatively high measurement errors.     

Can the aspiration detected by videofluoroscopic swallowing studies predict long-term survival in stroke patients with dysphagia?

PURPOSE: This study aimed to evaluate whether the aspiration detected by videofluoroscopic swallowing study (VSS) could predict the long-term survival in stroke patients with dysphagia in the post-acute phase of stroke. METHODS: A cohort of 182 consecutive patients with stroke-related dysphagia referred for VSS from July 1994 to April 1999 was retrospectively constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. The records thus obtained were then linked to the National Death Register to track the occurrence of patient deaths until December 31, 2000. RESULTS: Of the 182 patients, 91 (50%) showed aspiration during VSS performed for a median duration of 8.4 weeks after stroke, and 76 (42%) had silent aspiration. In the post-acute phase of stroke (14.7 +/- 8.7 weeks after stroke, mean + standard deviation), 56 (31%) were tube-fed, and 88 (48%) were wheelchair-confined. A total of 65 patients died in a median follow-up duration of 30.8 months after VSS. Patients were classified into three groups based on the findings of VSS-detected aspiration or penetration, but no difference was noted in their survival curves. In the Cox stepwise regression analysis, only advanced age, recurrent stroke (hazard ratio 1.74, 95% CI 1.06-2.85), the need of tube-feeding (hazard ratio 2.07, 95% CI 1.19-3.59), and being wheelchair-confined (hazard ratio 2.83, 95% CI 1.54-5.19) during follow-up were independent predictors of long-term survival. CONCLUSIONS: VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia.