脑卒中吞咽障碍患者间歇性经口至食管管饲管理的循证实践

doi:10.3761/j.issn.1672-9234.2025.07.017

摘要/Abstract

摘要：

目的基于脑卒中吞咽障碍患者间歇性经口至食管管饲（intermittent oro-esophageal tube feeding, IOE）管理的最佳证据，实施循证实践，并评价其效果。方法以乔安娜布里格斯研究所临床证据实践应用模式为框架，基于证据制订审查指标。于2024年7月—9月开展基线审查，分析障碍因素并开展实践变革。于2024年10月—12月进行变革后审查。比较证据应用前后的审查指标执行率、护士IOE管理相关的理论知识和操作技能水平、第一次置管一次性成功率、置管过程中患者恶心/误吸发生率、IOE干预对患者营养状况指标的改善情况。结果证据应用后，19项审查指标执行率明显提高，护士IOE管理相关理论知识和操作技能考核得分、置管过程中患者误吸发生率、患者体重与BMI变化率均优于证据应用前（P<0.05）。结论脑卒中吞障碍患者IOE管理循证实践促进了护士IOE管理相关知识、技能水平的提升及临床行为的落实，同时能够减少置管不良反应，改善患者营养状态。

关键词: 护理, 脑卒中后吞咽障碍, 间歇性经口至食管管饲, 循证实践

Abstract:

Objective To implement evidence-based practice（EBP） based on the best available evidence for managing intermittent oroesophageal tube feeding（IOE） in stroke patients with dysphagia and evaluate its effects. Methods Guided by the Joanna Briggs Institute（JBI） Model of Evidence-Based Healthcare，audit indicators were formulated based on evidence. A baseline audit was conducted from July to September 2024 to evaluate current practices. Subsequently，barriers were analyzed，and practice improvements were initiated based on the audit findings. A post-implementation audit was performed from October to December 2024 to compare pre- and post-intervention outcomes，including compliance with audit indicators，nurses’ theoretical knowledge level and practical skills in IOE management，first-attempt success rate of tube placement，incidence of patient nausea/aspiration during placement，and improvements in nutritional status indicators following IOE intervention. Results After the implementation，significant improvements were observed in all 19 audit indicators. Nurses’ scores in theoretical and practical assessments of IOE management，and the changes rate of weight and BMI in patients were significantly improved（P<0.05）. In addition，the incidence of aspiration during tube placement got significantly reduced（P<0.05）. Conclusion The EBP protocol for IOE management in stroke patients with dysphagia can enhance nurses’ knowledge，skills，and adherence to clinical guidelines. It is also helpful in improving first-attempt success rates，reducing adverse reactions during tube placement，and optimizing patients’ nutritional outcomes.

Key words: Nursing, Post-stroke dysphagia, Intermittent oro-esophageal tube feeding, Evidence-based practice

郑志敏, 陈仁, 伍丽欣, 符奋, 谢小欢, 温梦玲, 李春霞. 脑卒中吞咽障碍患者间歇性经口至食管管饲管理的循证实践[J]. 中华护理教育, 2025, 22(7): 874-881.

ZHENG Zhimin, CHEN Ren, WU Lixin, FU Fen, XIE Xiaohuan, WEN Mengling, LI Chunxia. Intermittent oro-esophageal tube feeding for patients with post-stroke dysphagia：the best evidence practice of management[J]. Chinese Journal of Nursing Education, 2025, 22(7): 874-881.

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