中医延续护理对脑卒中吞咽障碍出院患者居家康复的中期应用效果

Effect of Traditional Chinese Medicine Continuous Nursing on Home-Based Rehabilitation of Discharged Stroke Patients with Dysphagia in Medium-Term Follow-Up

摘要: 目的：观察基于居家安全中医适宜技术构建的延续护理方案对脑卒中后吞咽障碍出院患者中期康复效果的影响。方法选取2026年1~7月本院神经内科82例脑卒中合并吞咽障碍出院患者，按随机数字表法分为对照组与观察组，各41例。对照组予常规出院指导及月度电话随访；观察组在此基础上实施颈部穴位推拿、耳穴压豆、辨证膳食指导、中医吞咽导引训练联合微信 + 电话 + 门诊多维随访的中医延续护理，干预3个月。比较两组洼田饮水试验分级、微型营养评估简表(MNA‑SF)、吞咽障碍特异性生活质量量表(SWAL‑QOL)及Zarit照护者负担量表评分。结果干预3个月后，观察组洼田饮水试验分级优于对照组(Z = −2.314, p = 0.021)；MNA‑SF评分(10.52 ± 1.74)高于对照组(9.33 ± 1.66)，t = 3.21，p = 0.002；SWAL‑QOL评分(71.42 ± 7.96)高于对照组(66.25 ± 8.13)，t = 2.98，p = 0.004；Zarit评分(34.18 ± 5.83)低于对照组(38.62 ± 6.17)，t = −3.42，p = 0.001。结论中医延续护理方案可切实改善脑卒中吞咽障碍出院患者的吞咽功能、营养状况、生活质量，并减轻家庭照护负担，适宜在居家康复场景中推广。

Abstract: Objective: To investigate the effect of a continuous nursing scheme developed based on safe home-based traditional Chinese medicine (TCM) appropriate techniques on the medium-term rehabilitation outcomes of discharged stroke patients with dysphagia. Methods: A total of 82 discharged patients with stroke complicated by dysphagia who were admitted to the Department of Neurology of our hospital from January to July 2026 were enrolled and randomly divided into a control group and an observation group using a random number table, with 41 patients in each group. The control group received routine discharge guidance and monthly telephone follow-up. On this basis, the observation group received TCM continuous nursing interventions, including neck acupoint massage, auricular point pressing with beans, syndrome-differentiated dietary guidance, and TCM swallowing daoyin training, combined with multidimensional follow-up via WeChat, telephone, and outpatient visits, for 3 months. The Kubota Water Swallowing Test grade, Mini Nutritional Assessment-Short Form (MNA-SF), Swallowing Quality of Life Questionnaire (SWAL-QOL), and Zarit Caregiver Burden Scale scores were compared between the two groups. Results: After 3 months of intervention, the Kubota Water Swallowing Test grade in the observation group was better than that in the control group (Z = −2.314, p = 0.021). The MNA-SF score in the observation group was higher than that in the control group (10.52 ± 1.74 vs. 9.33 ± 1.66; t = 3.21, p = 0.002). The SWAL-QOL score was also higher in the observation group than in the control group (71.42 ± 7.96 vs. 66.25 ± 8.13; t = 2.98, p = 0.004). The Zarit Caregiver Burden Scale score was lower in the observation group than in the control group (34.18 ± 5.83 vs. 38.62 ± 6.17; t = −3.42, p = 0.001). Conclusion: The TCM continuous nursing scheme can effectively improve swallowing function, nutritional status, and quality of life and reduce family caregiver burden among discharged stroke patients with dysphagia. It is suitable for promotion in home-based rehabilitation settings.