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Article(id=1322167915911164749, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167871413796899, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.03.017, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742745600000, receivedDateStr=2025-03-24, revisedDate=1767715200000, revisedDateStr=2026-01-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793158995845, onlineDateStr=2026-10-28, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793158995845, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793158995845, creator=13701087609, updateTime=1793158995845, updator=13701087609, issue=Issue{id=1322167871413796899, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='3', pageStart='353', pageEnd='528', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158985236, creator='13701087609', updateTime=1793158985236, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=473, endPage=478, ext={EN=ArticleExt(id=1322167916133462862, articleId=1322167915911164749, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Qualitative study on thirsty experience and needs of stroke patients with nasal feeding, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the experience of thirst and needs in stroke patients with nasal feeding,and to provide reference for the construction of thirst management program for stroke patients with nasal feeding.

Methods

A descriptive qualitative research method was used to select 16 stroke patients with thirst after nasal feeding in the Department of Neurology of a tertiary grade A hospital in Suzhou city from August to October 2024.The purposive sampling method was used to conduct semi-structured interviews.Based on the theory of unpleasant symptoms,the data were analyzed by directional content analysis combined with traditional content analysis.

Results

A total of five themes were extracted:the characteristics of thirst symptoms(the nature of thirst was burning and knife-like,the time and intensity of occurrence had individual differences,and the degree of distress to patients),the attribution of thirst(physiological factors,psychological factors,environmental factors),the impact of thirst(physical pain,psychological suffering,irrational behavior),the coping of thirst(various coping styles,limitations of coping effects,and concerns about the safety of coping),and unmet needs(emotional and social needs,information needs).

Conclusions

The problem of thirst in stroke patients with nasal feeding is prominent.It is suggested that nursing staff should strengthen the understanding of thirst symptoms and carry out multi-dimensional evaluation,identify multiple influencing factors of thirst in the early stage,pay attention to the negative impact of thirst on patients,and develop a thirst management model of nursing staff as the leading factor and family as the unit and co-participation.

, authors=Sheng HUANG1, 2, Zhi WANG3, Xi PAN3, Huiling LI1, 2, authorsList=Sheng HUANG, Zhi WANG, Xi PAN, Huiling LI, authorCompany=null, correspAuthors=Huiling LI, authorNote=null, correspAuthorsNote=
LI Huiling, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322167916385121103, articleId=1322167915911164749, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=脑卒中鼻饲病人口渴体验及需求的质性研究, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探究脑卒中鼻饲病人口渴的体验及需求，为构建脑卒中鼻饲病人口渴管理方案提供参考。

方法

采用描述性质性研究方法，于2024年8月—10月采用目的抽样法选取苏州市某三级甲等医院神经内科16例脑卒中鼻饲后口渴病人进行半结构式访谈，并以不悦症状理论为框架，采用定向内容分析法结合传统内容分析法进行资料分析。

结果

共提炼出5个主题：口渴症状的特征（口渴的性质呈烧灼、刀割样，出现的时间及强度具有个体差异，对病人的困扰程度重）、口渴的归因（生理因素，心理因素，环境因素）、口渴的影响（身体痛苦，心理煎熬，出现非理性行为）、口渴的应对（积极应对与被动依赖并存，缓解效果的局限性，对应对过程安全性的担忧）以及未满足需求（情感及社交需求，信息需求）。

结论

脑卒中鼻饲病人口渴问题突出，建议护理人员加强对口渴症状的认识并开展多维度的评估，早期识别口渴的多重影响因素，重视口渴对病人的负面影响，发展以护理人员为主导，家庭为单位共同参与的口渴管理模式。

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黄盛，主管护师，硕士研究生在读

, correspAuthorsNote=
李惠玲，E-mail：
LI Huiling, E-mail:
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General information of patients with stroke（n=16）

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编号年龄（岁）性别学历洼田饮水试验治疗措施鼻饲时间（d）疾病诊断基础疾病自理能力
N163男高中5级鼻胃管+鼻导管吸氧11脑梗死糖尿病、高血压重度依赖
N266男小学5级鼻胃管+鼻导管吸氧4脑梗死高血压中度依赖
N373女小学4级鼻胃管+鼻导管吸氧10脑梗死高血压重度依赖
N453男初中4级鼻胃管+鼻导管吸氧6脑梗死无重度依赖
N535女本科4级鼻胃管+鼻肠管+鼻导管吸氧14脑出血无重度依赖
N672女小学4级鼻胃管+鼻导管吸氧6脑梗死糖尿病、高血压重度依赖
N772男小学4级鼻胃管4脑梗死高血压重度依赖
N845男高中5级鼻胃管+鼻导管吸氧8脑梗死高血压重度依赖
N978男小学4级鼻胃管+鼻导管吸氧6脑梗死高血压重度依赖
N1072男小学5级鼻胃管+鼻导管吸氧6脑梗死高血压重度依赖
N1149男初中4级鼻肠管+鼻导管吸氧25脑梗死糖尿病重度依赖
N1272男初中5级鼻胃管3脑梗死糖尿病、高血压重度依赖
N1368女小学5级鼻胃管+鼻导管吸氧3脑梗死糖尿病中度依赖
N1479男初中4级鼻胃管+鼻导管吸氧4脑梗死高血压重度依赖
N1579男高中5级鼻胃管+面罩吸氧5脑梗死高血压重度依赖
N1665女初中4级鼻胃管+鼻导管吸氧5脑梗死高血压重度依赖
), ArticleFig(id=1322529998070731050, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167915911164749, language=CN, label=表1, caption=

脑卒中病人一般资料（n=16）

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编号年龄（岁）性别学历洼田饮水试验治疗措施鼻饲时间（d）疾病诊断基础疾病自理能力
N163男高中5级鼻胃管+鼻导管吸氧11脑梗死糖尿病、高血压重度依赖
N266男小学5级鼻胃管+鼻导管吸氧4脑梗死高血压中度依赖
N373女小学4级鼻胃管+鼻导管吸氧10脑梗死高血压重度依赖
N453男初中4级鼻胃管+鼻导管吸氧6脑梗死无重度依赖
N535女本科4级鼻胃管+鼻肠管+鼻导管吸氧14脑出血无重度依赖
N672女小学4级鼻胃管+鼻导管吸氧6脑梗死糖尿病、高血压重度依赖
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脑卒中鼻饲病人口渴体验及需求的质性研究
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黄盛 1, 2 , 王稚 3 , 潘习 3 , 李惠玲 1, 2, *, *
护理研究 | 综合研究 2026,40(3): 473-478
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护理研究 |综合研究 2026 , 40 (3) : 473 -478
脑卒中鼻饲病人口渴体验及需求的质性研究
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黄盛1, 2, 王稚3, 潘习3, 李惠玲1, 2, *, *
作者信息
  • 1苏州大学苏州医学院护理学院，江苏 215006
  • 2苏州市老年智慧护理与康养重点实验室
  • 3苏州大学附属第一医院
通讯作者:
李惠玲，E-mail：
LI Huiling, E-mail:
作者简介:

黄盛，主管护师，硕士研究生在读

Qualitative study on thirsty experience and needs of stroke patients with nasal feeding
Sheng HUANG1, 2, Zhi WANG3, Xi PAN3, Huiling LI1, 2
Affiliations
  • 1School of Nursing, Suzhou Medical College of Soochow University, Jiangsu 215006 China
  • 2Suzhou Key Laboratory of Geriatric Intelligent Nursing and Health Preservation
  • 3The First Affiliated Hospital of Soochow University
    • Corresponding Author:
    LI Huiling, E-mail:
出版时间: 2026-02-10 doi: 10.12102/j.issn.1009-6493.2026.03.017
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摘要
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目的

探究脑卒中鼻饲病人口渴的体验及需求，为构建脑卒中鼻饲病人口渴管理方案提供参考。

方法

采用描述性质性研究方法，于2024年8月—10月采用目的抽样法选取苏州市某三级甲等医院神经内科16例脑卒中鼻饲后口渴病人进行半结构式访谈，并以不悦症状理论为框架，采用定向内容分析法结合传统内容分析法进行资料分析。

结果

共提炼出5个主题：口渴症状的特征（口渴的性质呈烧灼、刀割样，出现的时间及强度具有个体差异，对病人的困扰程度重）、口渴的归因（生理因素，心理因素，环境因素）、口渴的影响（身体痛苦，心理煎熬，出现非理性行为）、口渴的应对（积极应对与被动依赖并存，缓解效果的局限性，对应对过程安全性的担忧）以及未满足需求（情感及社交需求，信息需求）。

结论

脑卒中鼻饲病人口渴问题突出，建议护理人员加强对口渴症状的认识并开展多维度的评估，早期识别口渴的多重影响因素，重视口渴对病人的负面影响，发展以护理人员为主导，家庭为单位共同参与的口渴管理模式。

脑卒中  /  鼻饲  /  口渴  /  质性研究  /  护理
Objective

To explore the experience of thirst and needs in stroke patients with nasal feeding,and to provide reference for the construction of thirst management program for stroke patients with nasal feeding.

Methods

A descriptive qualitative research method was used to select 16 stroke patients with thirst after nasal feeding in the Department of Neurology of a tertiary grade A hospital in Suzhou city from August to October 2024.The purposive sampling method was used to conduct semi-structured interviews.Based on the theory of unpleasant symptoms,the data were analyzed by directional content analysis combined with traditional content analysis.

Results

A total of five themes were extracted:the characteristics of thirst symptoms(the nature of thirst was burning and knife-like,the time and intensity of occurrence had individual differences,and the degree of distress to patients),the attribution of thirst(physiological factors,psychological factors,environmental factors),the impact of thirst(physical pain,psychological suffering,irrational behavior),the coping of thirst(various coping styles,limitations of coping effects,and concerns about the safety of coping),and unmet needs(emotional and social needs,information needs).

Conclusions

The problem of thirst in stroke patients with nasal feeding is prominent.It is suggested that nursing staff should strengthen the understanding of thirst symptoms and carry out multi-dimensional evaluation,identify multiple influencing factors of thirst in the early stage,pay attention to the negative impact of thirst on patients,and develop a thirst management model of nursing staff as the leading factor and family as the unit and co-participation.

stroke  /  nasal feeding  /  thirst  /  qualitative research  /  nursing
黄盛, 王稚, 潘习, 李惠玲. 脑卒中鼻饲病人口渴体验及需求的质性研究. 护理研究, 2026 , 40 (3) : 473 -478 . DOI: 10.12102/j.issn.1009-6493.2026.03.017
Sheng HUANG, Zhi WANG, Xi PAN, Huiling LI. Qualitative study on thirsty experience and needs of stroke patients with nasal feeding[J]. Chinese Nursing Research, 2026 , 40 (3) : 473 -478 . DOI: 10.12102/j.issn.1009-6493.2026.03.017
正文
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脑卒中是全球范围内导致死亡和残疾的主要原因之一[1]，吞咽障碍是脑卒中后常见的并发症，发生率为34.11%~80.05%[2]。由于无法正常摄取水分和营养，约80%的吞咽障碍病人需要依赖管饲满足其生理需求[3]。研究表明，鼻饲病人与管饲相关最常见和最痛苦的症状之一就是感到口渴[4]。口渴作为一种引起人强烈饮水欲望的主观感受，是机体有效循环容量及水电解质体液调节失衡的预警反应之一[5]。脑卒中鼻饲病人因神经损伤、药物治疗等原因常面临着口渴的困扰[6]，口渴给病人带来了一系列主观的不适，不但会引发病人焦虑、抑郁等负性情绪，还增加其应激反应和代谢负担[5]。此外，长期的口渴和随之而来的脱水状态可能对病人的神经可塑性造成损害，脑部灌注减少，从而增高脑卒中复发风险[7]。Lenz等[8]于1977年在症状相关研究成果以及理论分析的基础上提出了不悦症状理论（the theory of unpleasant symptoms，TOUS）。该理论认为症状是个体在不同环境中出现的一种主观体验，通过对不悦症状核心概念的阐述，可以构建护理对象症状的整体情况。目前，国内外关于脑卒中鼻饲病人口渴的研究多集中于评估、干预等量性研究上[6,9]，而口渴作为一种主观感受，有关其口渴体验的质性研究较少。因此，本研究拟对脑卒中鼻饲病人进行深入访谈，探索其口渴这一不悦症状的真实体验与护理需求，旨在为护理人员提供对病人口渴症状的全面理解，优化病人的护理质量和症状管理效果。
1　对象与方法
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1.1　研究对象
采用目的抽样法，选取2024年8月—10月苏州市某三级甲等综合医院神经内科收治的脑卒中鼻饲后口渴病人为研究对象。纳入标准：1）符合《中国各类主要脑血管病诊断要点2019》[10]中脑卒中的诊断标准，经头颅CT或磁共振成像（MRI）诊断为脑卒中；2）病人意识清楚，能配合交流；3）鼻饲时间≥2 d；4）口渴数字评分法（Numerical Rating Scale，NRS）得分≥3分；5）自愿参与本研究。排除标准：1）生命体征不平稳或合并身体其他重要脏器衰竭；2）严重的肾脏衰竭或心力衰竭，需要限制液体的病人；3）认知功能障碍或患有精神疾病者；4）确诊干燥综合征、唾液腺器质性疾病。样本量以信息饱和后再访谈3例脑卒中鼻饲后口渴病人无新主题产生为准，最终访谈16例病人，编号N1~N16。所有病人均知情同意且自愿参加本研究，脑卒中病人一般资料见表1。本研究已获得苏州大学附属第一医院医学伦理委员会回顾性/非干预性研究批准（审核编号：〔2024〕伦研批第462号）。
1.2　研究方法
1.2.1　确定访谈提纲
依据研究目的，查阅相关文献，拟定初步访谈提纲。正式开展访谈前，选取2例脑卒中鼻饲后口渴病人进行预访谈（资料不纳入结果分析），在听取受访者意见及1名老年护理专家、2名神经内科护士长、1名质性研究专家的指导和建议后，形成访谈提纲终稿。内容如下：1）您从置管到现在出现过口渴吗？描述一下您的感受？2）置管前后，您的口渴体验有什么变化？3）口渴对您有什么影响？4）出现口渴时您有哪些需求？5）您会如何去应对或得到了哪些帮助，效果如何？6）关于口渴，您还有什么体验、需求或经验分享？
1.2.2　资料收集方法
遵循描述性质性研究方法，采取半结构化访谈的方式收集资料。因病人普遍自理能力差，故访谈地点选择为病房，避开鼻饲、雾化等治疗时间，最大限度地确保环境安静。访谈开始前由访谈者向病人讲解访谈的目的、意义与方法，获得知情同意后进行录音。不悦症状理论将症状概念化为一种包含强度、时间、感知到的痛苦程度、性质在内的多维度体验[8]。考虑到并非每例受访者都能将症状的4个维度准确地表达出来。因此，在面对一些不完整的回答时，采用总结、追问的方式补充和澄清，并留意其肢体语言，每次访谈时间为20~30 min。访谈16例病人后信息基本饱和，继续访谈3例病人后无新的内容产生（资料不纳入分析），结束访谈。
1.2.3　资料整理和分析方法
研究者在访谈结束后的24 h内将录音内容转录为文字信息，并由1名研究生复核，确保内容的准确性和完整性。采用传统内容分析法结合定向内容分析法[11]进行资料分析：1）采用传统内容分析法逐字对访谈记录进行编码以提取关键短语；2）根据关键短语与不悦症状理论各维度的相似性和拟合度，对数据进行定向整理，将关键短语分组为子主题；3）完成定向内容分析后，编码者与团队成员讨论对无法归纳到不悦症状理论的内容赋予新的主题。
2　结果
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2.1　口渴症状的特征
2.1.1　口渴的性质呈烧灼、刀割样
口渴的性质被描述为烧灼、刀割样等强烈不适。P3：“干的感觉有点烧，嘴里面干，想喝水”。P12：“渴啊，感觉肚子里面有火在往上面烧”。P10：“喉咙干痛得厉害，好像在刀割，里面感觉要爆炸崩开了”。P2：“里面像是裂开来一样，干裂的那种感觉”。
2.1.2　出现的时间及强度具有个体差异
受访者对于口渴出现的时间以及口渴的强度感受不一。P2：“白天更干，一直想喝水”。也有受访者提到夜晚，尤其是前半夜干渴难耐。P14：“前半夜会觉得很干”。多数受访者表示只要醒着就处于干渴的状态。P4：“基本上就是醒着的时候一直是处于比较干、比较渴的状态”。对于口渴症状的强度，多数受访者表示呈中重度。P3：“现在应该是中度的”。P5：“对水的渴望应该是非常强烈，重度渴望”。P12：“重度的，渴得不行了”。
2.1.3　对病人的困扰程度重
部分受访者明确表示自己正在经历着极端的痛苦、崩溃。P1：“干的人要崩溃一样”。P2：“就很想喝水那种，晚上喝不了水感觉要活不下去了”。P7：“饭也没法吃，水也没法喝，干死了”。
2.2　口渴的归因
2.2.1　生理因素
在对口渴症状的主观解释上，受访者将口渴归因于多种因素，如张口呼吸、各种治疗、咳嗽咳痰等生理疾病因素。P13:“我张嘴呼气就容易干”。P3:“做这个的时候（手指雾化面罩）干得厉害，嘴唇周围干”。P2:“咳嗽吐痰（次数）多了，到最后感觉唾沫都吐没了”。
2.2.2　心理因素
部分受访者认为口渴症状与自身的情绪相伴随。P1:“人心情最低落的时候最干，还有情绪激动，心里最不舒服的时候最干”。P16：“渴了就很烦躁，心烦之后感觉好像更加渴了”。
2.2.3　环境因素
受访者将口渴与他们发病前的个人习惯、生活方式等社会环境因素以及温湿度、视觉刺激等物理环境因素相联系。P7:“以前杯子不离身的”。P8：“晚上最想（吃喝），以前经常和朋友一起吃夜宵，喝啤酒”。P4:“不知道是不是开了空调的缘故，就很干”。P5：“早上（护工）阿姨会弄一杯水在床头，看到（水）的时候就会想（喝水）”。
2.3　口渴的影响
2.3.1　身体痛苦
众多受访者表示长期的口渴带给他们包含咽喉部干痛、咽下困难、睡眠障碍在内的诸多负面影响。P4：“嗓子干得痛”。P3：“我这里面不干了，舒服了，才能休息一会，不然干得睡不着”。此外，还有受访者认为口渴伴随着的口腔干燥对他们的日常交流产生了负面影响。P9：“喉咙干得卡住了话都说不大出来了”。P14：“怕讲话，干得我都不想讲话，讲话多了更干”。
2.3.2　心理煎熬
受访者在面临口渴时会产生痛苦、无助、焦虑和愤怒等负性情绪。P8：“躺在这边，不让吃东西喝水，非常难受，哪怕给我一小口水喝，我受不了了”。P4：“很想喝水。但是现在不能喝水了”。P1：“渴的时候是会和家里人讲的，讲有什么用，不让吃（喝）水”。P10：“不让我吃不让我喝，我是来看病的，不是来受罪的”。
2.3.3　出现非理性行为
部分受访者在极度口渴和不适的影响下，其思维受到干扰，对医疗程序产生了误解，甚至做出反复拔管、言语攻击等一系列非理性的行为。P11：“你们是在搞什么‘饥饿疗法’吗，那种对身体强壮的人可能有点用，不让吃不让喝，像我这种瘦得不成样子的人，这个搞不了”。P10在住院期间出现2次自行拔管行为：“这个（胃管）给我拿掉，我就能不干。我喊他们拿掉，他们不拿，我就只好自己来”。P12性格急躁，在诉求饮水未得到满足后辱骂其配偶：“她就听医生的，不顾我死活，昨天晚上我渴死了，让她（配偶）给我倒壶水，她不肯”。
2.4　口渴的应对
2.4.1　积极应对与被动依赖并存
受访者在经历口渴时会采取自发地舔舐、吞咽、“搅海”等动作。P8：“一直干，我就一直舔嘴唇，舔了好像更干”。P5：“好久都没有喝到水了，有时候（护士打水时）感受到水通过喉咙有那种凉凉的感觉，我会不自主地吞咽，好像听说胃管都进去几厘米了”。个别受访者在经验中成长，不断调整应对策略。P3：“这是后面我自己想的办法，口干的时候，我用舌头这样（用舌尖以画圈的形式涂满整个口腔），这样子舔几遍之后，感觉唾沫会出来。唾沫出来之后往下面咽，会好点”。此外，绝大部分受访者因自理能力受限，需要被动依赖护理人员以及陪护人员的帮助。P10：“护士帮我擦嘴巴（口腔护理）会好一点”。P1：“他们（家属）会帮我用棉签蘸水涂一涂”。P11：“他们（家属）会给我抹油（液体石蜡）”。P12：“我家里人帮我买了个小喷壶，可以往嘴里喷水（缓解口渴）”。
2.4.2　缓解效果的局限性
受访者表示目前使用的缓解口渴的方法虽有效果，但作用强度和持续时间十分有限。P1：“擦完嘴巴之后，好像就没什么（渴）感觉了，但是缓解不超过10 min”。P12：“（喷雾）用了会好一点，但不会超过1 min”。此外，干预效果也受到病人偏好、情绪等多重影响。P2：“这个（液体石蜡）有用，但没有涂水的效果好。油涂了滑滑的，不大习惯”。P1：“（喷雾）效果要看我（心）烦不烦，心烦就不管用，心不烦的时候就管用得多”。
2.4.3　对应对过程安全性的担忧
除了缓解效果局限以外，部分受访者表达了自身及其家人对口渴应对过程安全性的担忧。P2：“护士给了这个（液体石蜡），他们（家属）怕我呛，不敢用”。P10：“我女儿不敢喷（喷雾），怕我呛”。P4：“我想喝，但我老婆不敢给我喝（水）”。P13发病后出现吞咽障碍，在外院经口进食了2 d反复呛咳：“干，但是怕喝水，刚开始几天自己喝水呛咳得厉害……咳得都吐了，这里（手指肺部）都咳得疼”。
2.5　未满足需求
2.5.1　情感及社交需求
受访者强调他对美食的渴望已经超越了生理需求，更多的是美食带给他的情感以及社交的满足。P8：“插管（胃管）之后最大的不舒服不是管子不舒服，是水不能喝，美食我不能吃。我肚子不饿，图的是美味的刺激，朋友之间那种吃喝，啤酒、牛奶、零食什么的这些都想吃”。
2.5.2　信息需求
此外，众多受访者表达了他们对口渴应对措施了解的匮乏。P4：“除了护士拿棉球擦以外，别的（缓解口渴的方法）不知道，我就很想喝水，他们（医护人员）不给我喝”。P10：“护士没说喷多少下，只让买（喷雾）”。P16：“有的护士让（用喷壶）喷，有的不让，我女儿又不懂，我们都是业余的，不知道听哪个护士的，就干脆不喷了”。在当前干预手段无法满足他们需求的情况下，呼吁研究团队尽快找到更有效的解决方案。P1：“我要跟你提个建议，你们（团队）要赶紧研究开发一个（方案）让我们没那么干，缓解病人的痛苦，你这个要解决的，研究开发的（方案）一定要有用”。
3　讨论
收起
3.1　重视脑卒中鼻饲病人口渴症状体验，开展多维度的症状评估
本研究结果显示，对于脑卒中鼻饲病人来说，口渴这一不悦症状感知因个体差异有所不同，但多数受访者存在着高强度且持续的口渴现象，与Zhao等[12]研究结果一致。鼻饲管虽能直接将水分输送至消化道，但无法有效激活口腔和咽喉部位的水分感知机制[13]。此外，鼻腔内有管道阻挡，常引起病人张口呼吸，加剧其口渴体验。脑卒中病人发病急，病情进展快，许多危及病人生命的症状使得病人口渴症状评估被边缘化[14]。研究表明，在那些使用鼻胃管伴或不伴禁食禁水的病人中，仅有13.6%的病人曾被医生或护士询问口渴情况[15]。不悦症状理论认为，有效的症状评估应涵盖强度、持续时间、困扰程度和性质4个维度[8]，以帮助医护人员全面了解症状的发生、发展和转归，从而更好地进行症状管理。然而，现有研究多评估其中单个或2个维度[16]。因此，建议护理人员加强对脑卒中鼻饲病人口渴症状的重视，综合评估口渴症状的多个维度，全面理解口渴症状的发生、发展和变化过程，以便对症状进行高效管理。
3.2　早期识别口渴多重影响因素，提前预防可管理的危险因素
本研究结果显示，脑卒中病人将口渴归结于生理疾病、各种治疗、情绪波动、生活方式等在内的多重因素影响。不悦症状理论也指出，症状体验会受到生理、心理和背景层面的共同影响[8]。研究表明，通过早期积极识别病人口渴的危险因素并制定相应措施，能有效预防或减轻病人口渴症状的出现[17]。首先，在生理层面上，对于合并张口呼吸的病人，应使用具有加温、加湿的氧疗装置，以减少呼吸道水分丢失[18]；对于脑卒中病人鼻饲出现喂养不耐受的情况，如呕吐、腹泻等，应及时处理并不断优化肠内营养流程；对于使用可能导致脱水的药物（如脱水利尿剂）以及痰液黏稠者应加强管理，避免液体负平衡的发生[19]。其次，在心理层面上，应重视病人的情感需求，提供及时的情绪支持和心理疏导。再者，环境因素也不容忽视，保持环境温湿度适宜，减少一切可能引起口渴的外部诱因。通过对这些可管理的危险因素进行综合预防，以提升病人的整体舒适度和护理质量。
3.3　重视口渴症状对病人的影响，引导脑卒中鼻饲病人积极应对
本研究结果显示，持续的口渴给脑卒中病人的身体、心理等带来了一系列负面的影响。在身心双重煎熬下，部分病人出现与家人的语言冲突、非计划拔管等负面行为，与李营阳等[20]研究结果一致。非计划拔管行为通常被认为是带管病人因多种需要无法有效表达和满足时出现的补偿行为，是一种带有目的性的活动[21]。口渴作为压力源之一，与疾病共同影响了病人的判断力和决策能力[22]，部分病人不能理解为什么他们不被允许经口进食饮水，生理上对食物和水的需求长期得不到满足使得他们感到极度的挫败和不满，进而出现了对抗性行为。因此，医护人员需要更加注重与病人的沟通以及需求评估，帮助病人理解治疗的作用及必要性，减轻其焦虑情绪。研究表明，家人的关怀能缓解病人心理压力，同伴的支持是促进病人康复的重要推力[23]。因此，需重视病人的社会支持网络，通过家属及朋友的情感支持、病友的同伴教育等满足病人生理、心理多方面的需求，帮助其建立积极的应对方式，顺利度过口渴的困境。
3.4　弥合信息差距，构建以护士为主导、家庭为单位，共同参与的口渴科学管理模式
本研究结果显示，脑卒中病人对于口渴应对方式的知晓程度有限，且现有的应对方式缓解效果局限，病人迫切渴望得到更有效、更持久的口渴应对指导。鲍少蕊等[6]使用1%苹果酸喷雾剂对脑卒中鼻饲病人的口渴进行干预，结果显示，1%苹果酸喷雾剂能显著减轻其口渴程度，并改善其睡眠质量。包丽研[9]使用冰盐水喷洒吞咽障碍病人的口腔黏膜，结果表明其能有效缓解病人的口渴感。二者均优于传统的棉签蘸水湿润方法，可在临床实践中考虑使用。此外，确保脑卒中鼻饲病人口渴缓解的安全性也至关重要，巴西Londrina州立大学Do Nascimento等[24]开发的口渴管理模型提出了一系列的口渴安全策略，旨在确保口渴护理的安全，该策略的可行性及有效性已在不同病人群体中得到了验证[25]，未来可考虑根据脑卒中病人特征将该策略进行调适使用。再者，脑卒中病人对口渴应对过程中的安全担忧同样会降低口渴缓解措施的有效性和安全性。因此，确保脑卒中鼻饲病人和其家属获得必要的信息教育，满足其对口渴症状管理和风险识别的信息需求，对于提升家庭的应对能力至关重要。未来的研究方向应聚焦发展一种以护士为主导、以家庭为单位，共同参与的口渴管理模式，以促进更科学、更全面的护理实践。
4　小结
收起
本研究通过质性研究揭示了脑卒中鼻饲病人存在着高强度、长时间的口渴不悦体验，给病人带来诸多负面影响，病人及其照顾者迫切渴望有效性和安全性并存的止渴措施。建议护理人员提高对病人口渴症状多维度体验的认识，早期识别口渴的多重影响因素，重视口渴对病人的负面影响，充分考虑脑卒中鼻饲病人的病情特点及个人偏好，以证据为基础，发展以护理人员为主导，家庭为单位共同参与的口渴管理模式。本研究仅对病人进行了单一时间点的访谈，今后可进一步开展研究，分析随着病人鼻饲留置时间的延长，其口渴体验及需求的发展规律。

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2026年第40卷第3期
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doi: 10.12102/j.issn.1009-6493.2026.03.017
  • 接收时间：2025-03-24
  • 首发时间：2026-10-28
  • 出版时间：2026-02-10
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  • 收稿日期：2025-03-24
  • 修回日期：2026-01-07
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    1苏州大学苏州医学院护理学院，江苏 215006
    2苏州市老年智慧护理与康养重点实验室
    3苏州大学附属第一医院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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