Effect of stratified nursing model in patients with dysphagia after stroke
分层护理模式在脑卒中后吞咽障碍患者中的效果分析

摘要

目的 探讨基于患者吞咽功能分层与护士层级匹配的分层护理模式，对脑卒中后吞咽障碍患者吞咽功能恢复、并发症发生率及营养指标的影响，聚焦分层护理的实施效果展开分析。方法 选取2024年3月—2025年7月收治的106例脑卒中后吞咽障碍患者为研究对象，采用随机数字表法分为对照组（53例）与干预组（53例）。对照组实施常规吞咽护理，干预组采用“患者吞咽分层-护士层级匹配”的分层护理模式：依据洼田饮水试验将患者分为轻、中、重度障碍层，对应匹配低年资、高年资护士实施个性化护理，持续干预10天。比较两组吞咽功能分级、吸入性肺炎发生率及营养指标水平。结果 干预后，干预组洼田饮水试验Ⅰ-Ⅱ级占比81.13%，高于对照组的56.60%（χ2=9.254，P=0.002）；吸入性肺炎发生率3.77%，低于对照组的18.87%（χ2=5.841，P=0.016）；血清白蛋白（38.45±3.21）g/L、血红蛋白（134.89±10.76）g/L，均高于对照组（P＜0.05）。结论 “患者吞咽分层-护士层级匹配”的分层护理模式可精准对接患者需求与护理能力，显著促进吞咽功能恢复，降低并发症风险，改善营养状况，分层实施效果突出，值得临床推广。

Abstract

Objective To explore the effect of stratified nursing model based on the matching of patients' swallowing function stratification and nurses' level on the recovery of swallowing function, complication rate and nutritional indexes in patients with post-stroke dysphagia, and focus on analyzing the implementation effect of stratified nursing.
Methods A total of 106 patients with post-stroke dysphagia admitted from March 2024 to July 2025 were selected as the research objects, and randomly divided into control group (53 cases) and intervention group (53 cases) by random number table method. The control group received routine swallowing nursing, while the intervention group adopted the stratified nursing model of "patients' swallowing stratification-nurses' level matching": patients were divided into mild, moderate and severe disorder layers according to the Kubota drinking water test, and junior and senior nurses were matched correspondingly to implement personalized nursing, with continuous intervention for 10 days. The swallowing function classification, incidence of aspiration pneumonia and nutritional index levels were compared between the two groups.
Results After intervention, the proportion of Kubota drinking water test grade Ⅰ-Ⅱ in the intervention group was 81.13%,which was higher than 56.60% in the control group(χ2=9.254,P=0.002);the incidence of aspiration pneumonia was 3.77%,which was lower than 18.87% in the control group(χ2=5.841,P=0.016);serum albumin(38.45±3.21)g/L and hemoglobin(134.89±10.76)g/L were higher than those in the control group(P＜0.05).
Conclusion   The stratified nursing model of "patients' swallowing stratification-nurses' level matching" can accurately connect patients' needs with nursing capabilities, promote the recovery of swallowing function significantly, reduce the risk of complications, improve nutritional status, with prominent stratified implementation effect, and is worthy of clinical promotion.