中国妇幼保健

目的 探讨基于家庭赋权理论的老年女性脑卒中吞咽障碍患者饮食结构调整指导。方法 选取2023年1月—2024年12月温州医科大学附属第二医院神经内科收治的首次发病的脑卒中吞咽障碍患者为研究对象，依据样本量计算公式估算样本量为100例，采用随机数字表法将其分为对照组和观察组，每组各50例。对照组实施传统摄食管理，观察组在传统摄食管理基础上实施家庭赋权理论的摄食管理方案，根据改良的洼田饮水试验和容积-黏度吞咽功能测试(V-VST)评定吞咽功能，采用全自动生化分析仪检测血红蛋白(Hb)、白蛋白(Alb)及前白蛋白(PA)水平，测量肱三头肌皮褶厚度(TSF)，应用家庭照顾者能力测量表(FCTI)评估家庭照顾者能力，采用该院特设的满意度调查问卷评估患者干预满意度。结果 干预前，两组患者的洼田饮水试验分级比较差异无统计学意义(P>0.05)。干预后，观察组轻度障碍(Ⅰ、Ⅱ级)患者比例显著升高，中度障碍(Ⅲ级)比例显著降低(均P<0.05);两组重度障碍(Ⅳ、Ⅴ级)比例比较，差异均无统计学意义(均P>0.05)。干预3 d时，对照组和观察组患者V-VST阳性率(86.00%vs. 90.00%)比较差异无统计学意义(χ²=0.379,P>0.05);干预7 d、10d时，两组V-VST检测结果阳性率均降低，观察组患者干预7 d、10 d时V-VST阳性率(50.00%、38.00%)均显著低于对照组(70.00%、60.00%)，差异均有统计学意义(χ²=4.167、4.842，均P<0.05)。干预前，两组患者营养指标比较，差异均无统计学意义(均P>0.05)。干预后，观察组Hb[(146.15±14.84) g/L]、PA[(220.23±40.56) mg/L]、Alb[(36.96±4.14) g/L]及TSF[(8.35±0.78) mm]水平均高于对照组[(137.45±14.16) g/L、(203.31±40.12) mg/L、(34.79±4.05) g/L及(7.59±0.75)mm]，差异均有统计学意义(t=2.999、2.097、2.649及4.966，均P<0.05)。干预前，两组照顾者的照护能力评分比较差异均无统计学意义(均P>0.05)。干预后，观察组照护能力评分均显著优于对照组(均P<0.05)。对照组患者满意度为86.00%，观察组患者满意度为98.00%，观察组患者满意度高于对照组(χ²=4.891,P<0.05)。结论 基于家庭赋权理论的饮食结构调整对老年女性脑卒中吞咽障碍患者营养状况和吞咽改善具有积极影响，值得临床推广。

Objective To explore the guidance on dietary structure adjustment for elderly female stroke patients with dysphagia based on the theory of family empowerment. Methods Patients with dysphagia after the first onset of stroke admitted to the Department of Neurology of the Second Affiliated Hospital of Wenzhou Medical University from January 2023 to December 2024 were selected as the research subjects. The sample size was estimated to be 100 cases based on the sample size calculation formula. They were divided into the control group and the observation group by the random number table method,50 cases in each group. The control group implemented traditional feeding management,while the observation group implemented the feeding management plan based on the family empowerment theory on the basis of traditional feeding management. The swallowing function was evaluated according to the modified Wada drinking water test and volume-toviscosity swallowing function test( V-VST) The levels of hemoglobin( Hb),albumin( Alb) and prealbumin( PA) were detected by an automatic biochemical analyzer. The thickness of triceps skinfold( TSF) was measured. The family Caregiver capacity assessment Scale( FCTI) was applied to evaluate the capacity of family caregivers. The satisfaction survey questionnaire specially set up by the hospital was used to evaluate the patients' satisfaction. Results Before the intervention,there was no statistically significant difference in the classification of the Wada drinking water test between the two groups of patients( P> 0. 05). After the intervention,the proportion of patients with mild disorders( grade Ⅰand Ⅱ) in the observation group significantly increased,and the proportion of patients with moderate disorders( grade Ⅲ) significantly decreased( P<0. 05). There was no statistically significant difference in the proportion of severe disorders( grade Ⅳ and V) between the two groups( P> 0. 05). At 3 days of intervention,there was no statistically significant comparison of the positive rate of V-VST between the control group and the observation group( 86. 00% vs. 90. 00%)( χ²= 0. 379,P>0. 05); At 7 days and 10 days of intervention,the positive rates of V-VST detection results in both groups decreased. The positive rates of V-VST in the observation group( 50. 00%,38. 00%)at 7 days and 10 days of intervention were both significant,the scores were lower than those of the control group( 70. 00%,60. 00%),and the differences were statistically significant( χ²= 4. 167,and 4. 842,all P< 0. 05). Before the intervention,there was no statistically significant difference in nutritional indicators between the two groups of patients( P>0. 05). After the intervention,observation group: Hb [( 146. 15±14. 84) g/L],PA [( 220. 23±40. 56) mg/L],Alb [( 36. 96±4. 14) g/L]and TSF [( 8. 35±0. 78) mm],the levels were all higher than those of the control group [( 137. 45±14. 16) g/L,( 203. 31±40. 12) mg/L,( 34. 79±4. 05) g/L,( 7. 59±0. 75)mm],the differences were all statistically significant( t = 2. 999,2. 097,2. 649,and 4. 966,all P<0. 05). Before the intervention,there was no statistically significant difference in the scores of care ability between the two groups of caregivers( P>0. 05). After the intervention,the scores of care ability in the observation group were significantly better than those in the control group( P<0. 05). The satisfaction rate of patients in the control group was 86. 00%,and that in the observation group was 98. 00%,the satisfaction rate of patients in the observation group was higher than that in the control group( χ²= 4. 891,P<0. 05). Conclusion The dietary structure adjustment based on the family empowerment theory has a positive impact on the nutritional status and swallowing improvement of elderly female stroke patients with dysphagia,and was worthy of clinical promotion.