摘要
目的研究基于纤维内镜吞咽功能评估(FEES)指导下的摄食训练对改善脑卒中患者吞咽功能的康复效果。方法选择60例入住南京医科大学附属无锡市同仁康复医院神经康复科因吞咽障碍留置胃管的脑卒中患者,分别纳入观察组和对照组进行回顾性病例对照研究。给予两组患者常规的神经康复训练和吞咽功能训练。根据改良容积-黏度测试结果,选择能够安全吞咽时液体的体积和稠度带管对对照组患者进行摄食训练;在FEES指导下通过选择安全进食的食物性状和一口量、指导吞咽技巧和代偿方法等对观察组患者进行直接摄食训练。分别于干预前和干预4周后评价两组患者的洼田饮水试验分级和功能性经口摄食量表评分,记录两组拔除胃管时间和胃管拔除率、肺炎发生率等指标变化。结果与对照组比较,干预后,观察组患者功能性经口摄食量表评分均值显著改善〔(5.33±0.48)分vs.(3.67±0.51)分,P<0.001)〕,干预期间肺炎发生率显著降低(6.7%vs.36.7%,P=0.005),拔除胃管时间减少〔(15.24±3.21)天vs.(19.36±3.58)天,P=0.019)〕,差异均有统计学意义。洼田饮水试验评级治愈率和显效率总和较对照组提高(66.7%vs.53.33%,P=0.329)、胃管拔除率升高(86.7%vs.73.3%,P=0.197),但差异无统计学意义。结论FEES指导下的直接摄食训练可有效保证患者进食安全,并改善其吞咽功能。
Objective To study the effect of feeding training guided by fibreoptic endoscopic evaluation of swallowing(FEES)on improving the swallowing function of stroke patients.Methods Sixty stroke patients who were admitted to the Department of Neurorehabilitation of hospital with indwelling gastric tube due to dysphagia were enrolled in the observation group and the control group for a retrospective case-control study.Both groups received routine neurological rehabilitation training and swallowing function training.The control group selected the volume and consistency of the liquid that could be swallowed safely according to the results of the modified volume-viscosity test,and took the tube for feeding training.Under the guidance of FEES,the observation group conducted direct food intake training by selecting safe food traits and bite sizes,guiding swallowing skills and compensatory methods.The water swallow test classification and functional oral feeding scale score of the two groups of patients were evaluated before the intervention and 4 weeks after the intervention,and the changes in the gastric tube removal time,gastric tube removal rate,and pneumonia incidence were recorded in the two groups.Results Compared with the control group,after the intervention,the mean value of the functional oral food intake scale score of the observation group was significantly improved〔(5.33±0.48)points vs.(3.67±0.51)points,P<0.001〕.During the intervention period,the incidence of pneumonia was significantly reduced(6.7%vs.36.7%),P=0.005),and the time to remove the gastric tube was reduced〔(15.24±3.21)days vs.(19.36±3.58)days,P=0.019〕,and the differences were statistically significant.The sum of the cure rate and the apparent rate of the water swallow test rating was higher than that of the control group(66.7%vs.53.33%,P=0.329),and the gastric tube removal rate was higher(86.7%vs.73.3%,P=0.197),but the difference was not statistically significant.significance.Conclusions Direct feeding training under the guidance of FEES swallowing assessment can effectively ensure the safety of eating and improve the swallowing function of patients with dysphagia.
作者
方红群
唐红
张鑫
尤莉
程红岩
FANG Hongqun;TANG Hong;ZHANG Xin;YOU Li;CHENG Hongyan(Neurorehabilitation Department,Wuxi Tongren Rehabilitation Hospital affiliated to Nanjing Medical University,Wuxi 214151,China;Rehabilitation Department,Wuxi Tongren Rehabilitation Hospital affiliated to Nanjing Medical University,Wuxi 214151,China)
出处
《医药高职教育与现代护理》
2022年第3期236-241,共6页
Medical Higher Vocational Education and Modern Nursing
关键词
吞咽障碍
摄食训练
纤维内镜吞咽评估
吞咽功能
Dysphagia
Feeding training
Fibreoptic endoscopic evaluation of swallowing
Swallowing function
