“ASK-T”防误吸管理模式在降低老年慢性阻塞性肺疾病合并吞咽障碍患者误吸风险中的应用

doi:10.3969/j.issn.1006-5725.2025.03.020

摘要/Abstract

摘要：

目的探讨“ASK-T”防误吸管理模式在降低老年慢性阻塞性肺疾病（COPD）合并吞咽障碍患者误吸风险中的应用效果。方法选取2021年7月至2024年6月广东省中医院大学城医院呼吸病科收治的409例COPD患者中合并误吸风险的196例患者作为本次研究对象，其中将2021年7月至2022年12月期间收治的102例COPD合并误吸风险的患者设为改善前组，该组患者在住院期间接受科室原有的护理流程和管理模式，将2023年1月至2024年6月期间收治的94例COPD合并误吸风险的患者设为改善后组，该组患者则在科室引入实施创新改善项目：“ASK-T”防误吸管理模式后接受护理管理，2组患者均观察、随访4周，比较2组误吸风险等级、标准吞咽功能评价量表（SSA）评分、吞咽障碍指数量表（DHI）评分情况、误吸与吸入性肺炎发生情况、患者的营养状态以及对干预后的满意度情况。结果对比得出，实施改善措施后，改善后组患者的误吸风险等级明显低于改善前组（P < 0.05），2组患者SSA评分、DHI各维度评分及DHI总评分较干预前均明显降低（P < 0.05），且改善后组患者SSA评分、DHI各维度评分及DHI总评分较改善前组更低（P < 0.05）；随访4周结果显示，2组患者营养风险筛查NRS-2002评分均低于干预前（P < 0.05），其中改善后组患者营养风险筛查NRS-2002评分明显较改善前组更低（P < 0.05）；对比显示，改善后组患者误吸及吸入性肺炎的发生率低于改善前组（P < 0.05），患者对误吸相关预防措施的满意度评分较改善前组更高（P < 0.05）。结论 “ASK-T”防误吸管理模式在老年COPD合并吞咽障碍患者的护理中，能显著降低误吸风险及吸入性肺炎的发生率，有效改善患者的吞咽功能和生活质量，同时提升患者的营养状态。此外，该模式还显著提高了患者对干预措施的满意度，为老年COPD合并吞咽障碍患者的临床护理提供了科学、有效的管理策略，值得在临床中推广应用。

关键词: “ASK-T”防误吸管理模式, 慢性阻塞性肺疾病, 老年患者, 吞咽障碍, 误吸风险

Abstract:

Objective To explore the application effect of the "ASK-T" aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease （COPD） complicated by dysphagia. Methods 196 of 409 COPD patients with aspiration risk admitted to the Respiratory Disease Department of Guangdong Provincial Hospital of Chinese Medicine， Higher Education Mega Center Hospital from July 2021 to June 2024 were selected as the study object， and 102 COPD patients with aspiration risk admitted from July 2021 to December 2022 were set as the pre-improvement group. The patients in this group received the original nursing process and management mode of the department during hospitalization. 94 COPD patients with aspiration risk admitted from January 2023 to June 2024 were set as the improved group， and the patients in this group were introduced into the department and implemented an innovative improvement project： "ASK-T" anti-aspiration management mode and then received nursing management. Patients in both groups were observed and followed up for 4 weeks. The risk grade of aspiration， SSA score， DHI score， aspiration pneumonia and aspiration pneumonia， nutritional status and satisfaction after intervention were compared between the two groups. Result The comparison showed that after the implementation of improvement measures， the aspiration risk grade of patients in the improved group was significantly lower than that in the pre-improvement group （P < 0.05）， and the SSA score， DHI score and total DHI score of patients in the 2 groups were significantly lower than that before intervention （P < 0.05）. The SSA score， DHI score and DHI total score in the improved group were lower than those in the pre-improved group （P < 0.05）. The results of 4-week follow-up showed that the scores of NRS-2002 for nutritional risk screening in 2 groups were lower than before intervention （P < 0.05）， and the scores of NRS-2002 for nutritional risk screening in the improved group were significantly lower than those in the pre-improvement group （P < 0.05）. The comparison showed that the incidence of aspiration and aspiration pneumonia in the improved group was lower than that in the pre-improved group （P < 0.05）， and the satisfaction score of patients with the relevant preventive measures was higher than that in the pre-improved group （P < 0.05）. Conclusion The "ASK-T" aspiration prevention management model， when applied in the nursing of elderly patients with COPD complicated by dysphagia， can significantly reduce the risk of aspiration and the incidence of aspiration pneumonia， effectively improve patients' swallowing function and quality of life， and enhance their nutritional status. Furthermore， this model significantly improves patient satisfaction with intervention measures， providing a scientific and effective management strategy for clinical nursing of elderly patients with COPD complicated by dysphagia. It is worthy of promotion and application in clinical practice.

Key words: "ASK-T" aspiration prevention management model, chronic obstructive pulmonary disease （COPD）, elderly patients, dysphagia, aspiration risk

中图分类号:

R563.3

何文芳,周逊,丁美祝,陈艺萍,刘倩丽,谈馨媛. “ASK-T”防误吸管理模式在降低老年慢性阻塞性肺疾病合并吞咽障碍患者误吸风险中的应用[J]. 实用医学杂志, 2025, 41(3): 434-441.

Wenfang HE,Xun ZHOU,Meizhu DING,Yiping CHEN,Qianli LIU,Xinyuan. TAN. Application of the "ASK⁃T" aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease （COPD） complicated by dysphagia[J]. The Journal of Practical Medicine, 2025, 41(3): 434-441.

图/表 8

表1

图1

表2

表3

表4

表5

表6

表7

参考文献 26

1	CHRISTENSON S A， SMITH B M， BAFADHEL M， et al. Chronic obstructive pulmonary disease［J］. Lancet，2022，399（10342）：2227-2242. doi:10.1016/s0140-6736(22)00470-6 doi: 10.1016/s0140-6736(22)00470-6
2	FAN Y， SHI Y， WU Y， et al. A nomogram-based prediction model for dysphagia in patients with chronic obstructive pulmonary disease： A cross-sectional study［J］. J Clin Nurs，2024，19（5）：361-365.
3	LI W， GAO M， LIU J， et al. The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease： A systematic review and meta-analysis［J］. Expert Rev Respir Med，2022，18（5）：567-574. doi:10.1080/17476348.2022.2086123 doi: 10.1080/17476348.2022.2086123
4	魏会强，郭丽萍，侯彦琨，等. 慢性阻塞性肺疾病患者发生肺损伤及肺动脉高压的危险因素及血清SDF-1、sRAGE的预测价值［J］. 实用医学杂志，2023，39（24）：3214-3221.
5	HUANG Y， ZHONG H， XU Z， et al. Assessing Swallowing Dysfunction Aggravation in Chronic Obstructive Pulmonary Disease Patients Using Ultrasonic Measurements With Swallowing Movement Parameters［J］. J Ultrasound Med，2024，43（3）：501-511. doi:10.1002/jum.16381 doi: 10.1002/jum.16381
6	韩慧，徐平，宋卫东. 高龄慢性阻塞性肺疾病稳定期患者近期急性加重风险预测模型构建［J］. 实用医学杂志，2023，39（22）：2984-2988. doi:10.3969/j.issn.1006-5725.2023.22.022 doi: 10.3969/j.issn.1006-5725.2023.22.022
7	HU W， LI T， CAO S， et al. Influence of Nurse-Led Health Education on Self-Management Ability， Satisfaction， and Compliance of Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Knowledge， Belief， and Practice Model［J］. Comput Math Methods Med，2022，16（9）：1782955.
8	中华医学会呼吸病学分会慢性阻塞性肺疾病学组，中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南（2021年修订版）［J］. 中华结核和呼吸杂志，2021，44（3）：170-205.
9	中国吞咽障碍膳食营养管理专家共识组. 吞咽障碍膳食营养管理中国专家共识（2019版）［J］. 中华物理医学与康复杂志，2019，41（12）：881-888.
10	D'NETTO P， RUMBACH A， DUNN K， et al. Clinical Predictors of Dysphagia Recovery After Stroke： A Systematic Review［J］. Dysphagia，2023，38（1）：1-22. doi:10.1007/s00455-022-10443-3 doi: 10.1007/s00455-022-10443-3
11	SILBERGLEIT A K， SCHULTZ L， JACOBSON B H， et al. The Dysphagia handicap index： Development and validation［J］. Dysphagia，2012，27（1）：46-52. doi:10.1007/s00455-011-9336-2 doi: 10.1007/s00455-011-9336-2
12	魏婷，刘晓霞，聂蓉. 基于网络互动平台的延续护理对老年吞咽障碍后误吸患者的效果评价［J］. 护理学杂志，2017，32（16）：93-95.
13	GUPTE T， KNACK A， CRAMER J D. Mortality from Aspiration Pneumonia： Incidence， Trends， and Risk Factors［J］. Dysphagia，2022，37（6）：1493-1500. doi:10.1007/s00455-022-10412-w doi: 10.1007/s00455-022-10412-w
14	刘莹，谭寅凤，王雷，等. 营养风险筛查结合患者主观整体评估与恶性肿瘤肌肉减少症的相关性［J］. 实用医学杂志，2022，38（2）：173-178. doi:10.3969/j.issn.1006⁃5725.2022.02.009 doi: 10.3969/j.issn.1006?5725.2022.02.009
15	THOMAS L H， MCCOLL E， PRIEST J， et al. Newcastle satisfaction with nursing scales： An instrument for quality assessments of nursing care［J］. Qual Health Care，1996，5（2）：67-72. doi:10.1136/qshc.5.2.67 doi: 10.1136/qshc.5.2.67
16	LIN T H， YANG C W， CHANG W K. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia［J］. Front Immunol，2022，12（7）：800029. doi:10.3389/fimmu.2021.800029 doi: 10.3389/fimmu.2021.800029
17	SILVA G D A P DA， FELTRIN T D， PICHINI F D S， et al. Quality of Life Predictors in Voice of Individuals With Chronic Obstructive Pulmonary Disease［J］. J Voice，2024，38（6）：1530. doi:10.1016/j.jvoice.2022.05.017 doi: 10.1016/j.jvoice.2022.05.017
18	OKU Y. Swallowing disorder-A possible therapeutic target for preventing COPD exacerbations［J］. Respir Physiol Neurobiol，2023，313（6）：104061. doi:10.1016/j.resp.2023.104061 doi: 10.1016/j.resp.2023.104061
19	ALANI S S， STIERWALT J A G， LAPOINTE L L， et al. An Investigation of Pulse Oximetry Levels During Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease［J］. Semin Speech Lang，2022，43（5）：361-377. doi:10.1055/s-0042-1743486 doi: 10.1055/s-0042-1743486
20	GAO J， ZHANG J. Bibliometric analysis of the effect of intermittent transoral esophageal-tube feeding on swallowing function in stroke patients［J］. Asian J Surg，2024，47（9）：4085-4086. doi:10.1016/j.asjsur.2024.05.039 doi: 10.1016/j.asjsur.2024.05.039
21	ORA L， WILKES L， MANNIX J， et al. Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease［J］. J Adv Nurs，2023，79（9）：3274-3285. doi:10.1111/jan.15605 doi: 10.1111/jan.15605
22	BEKELMAN D B， FESER W， MORGAN B， et al. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD， Heart Failure， or Interstitial Lung Disease： The ADAPT Randomized Clinical Trial［J］. JAMA，2024，331（3）：212-223. doi:10.1001/jama.2023.24035 doi: 10.1001/jama.2023.24035
23	WANG L， RUI W， CHEN S， et al. Effect of Enteral and Parenteral Nutrition Support on Pulmonary Function in Elderly Patients with Chronic Obstructive Pulmonary Disease Complicated by Respiratory Failure［J］. Comput Math Methods Med，2022，10（3）：4743070.
24	AMMOUS O， FEKI W， LOTFI T， et al. Inspiratory muscle training， with or without concomitant pulmonary rehabilitation， for chronic obstructive pulmonary disease （COPD）［J］. Cochrane Database Syst Rev，2023，1（1）：13778. doi:10.1002/14651858.cd013778.pub2 doi: 10.1002/14651858.cd013778.pub2
25	ZANABONI P， DINESEN B， HOAAS H， et al. Long-term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease： A Randomized Controlled Trial［J］. Am J Respir Crit Care Med，2023，207（7）：865-875. doi:10.1164/rccm.202204-0643oc doi: 10.1164/rccm.202204-0643oc
26	CEYHAN Y， TEKINSOY KARTIN P. The effects of breathing exercises and inhaler training in patients with COPD on the severity of dyspnea and life quality： A randomized controlled trial［J］. Trials，2022，23（1）：707. doi:10.1186/s13063-022-06603-3 doi: 10.1186/s13063-022-06603-3

组别	性别（例）		年龄（x ± s）/岁	BMI（x ± s）/（kg/m²）	教育程度/例			误吸风险等级/例
组别	男	女	年龄（x ± s）/岁	BMI（x ± s）/（kg/m²）	小学及以下	初中/高中	本科及以上	低风险	中风险	高风险
改善前组（n = 102）	65	37	70.95 ± 6.49	19.96 ± 2.45	18	55	29	23	53	26
改善后组（n = 94）	66	28	69.73 ± 7.21	20.17 ± 2.31	17	49	28	17	45	32
t/χ²/Z值	0.929		1.268	0.616	0.066			1.850
P值	0.335		0.206	0.539	0.968			0.396

组别	误吸风险等级
组别	无误吸风险	低风险	中风险	高风险
改善前组（n = 102）	2（1.96）	25（24.51）	58（56.86）	17（16.67）
改善后组（n = 94）	15（15.96）	50（53.19）	21（22.34）	8（8.51）
χ²值	38.581
P值	< 0.001

组别	SSA评分
组别	干预前	干预后	t值	P值
改善前组（n = 102）	34.58 ± 5.12	31.23 ± 6.47	4.101	< 0.001
改善后组（n = 94）	35.61 ± 4.75	28.35 ± 5.35	9.839	< 0.001
t值	1.457	3.380
P值	0.147	0.001

组别	生活质量各维度评分						总评分
	心理障碍		营养与呼吸功能受限		误吸症状		总评分
	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
改善前组（n = 102）	21.96 ± 2.89	20.93 ± 2.85^*	27.81 ± 3.93	26.52 ± 2.96^*	25.16 ± 4.11	23.56 ± 3.13^*	74.53 ± 9.87	71.23 ± 9.13^*
改善后组（n = 94）	21.78 ± 2.93	19.85 ± 2.79^*	27.79 ± 4.32	25.12 ± 3.98^*	24.51 ± 3.63	22.32 ± 2.89^*	73.56 ± 9.52	67.95 ± 8.21^*
t值	0.433	2.677	0.034	2.809	1.170	2.874	0.699	2.637
P值	0.666	0.008	0.973	0.005	0.244	0.005	0.485	0.009

组别	误吸	吸入性肺炎
改善前组（n = 102）	23（22.55）	18（17.65）
改善后组（n = 94）	12（12.77）	7（7.45）
χ²值	4.956	4.574
P值	0.026	0.032