早期吞咽障碍管理对预防脑卒中患者肺炎的临床研究  

Early Management of Dysphagia in Stroke Patients to Prevent Pneumonia:A Clinical Research

作　　者：李爱东[1] 张志[1] 周国强 黄宗青[1] 刘洪涛[1] 张娟 

机构地区：[1]深圳市第四人民医院神经内科,广东深圳518033

出　　处：《中华医院感染学杂志》2010年第11期1542-1544,共3页Chinese Journal of Nosocomiology

基　　金：深圳市福田区科研立项(FTWS024)

摘　　要：目的探讨早期吞咽障碍管理能否预防脑卒中后吞咽障碍患者吸入性肺炎的发生,为临床治疗提供新方向。方法对急性脑卒中患者,采用临床吞咽功能评估确定吞咽障碍及严重分级,用吞咽言语诊治仪评定吞咽肌群损伤程度;对不同程度的吞咽障碍患者90例,随机分为康复指导组27例、针灸组31例和管理组32例,3组均予常规药物治疗,康复指导组仅进行康复指导,针灸组在康复指导的基础上加用针灸,管理组是给予早期吞咽障碍的管理;治疗4周后,记录3组患者吸入性肺炎发生的情况及进行吞咽功能疗效评定。结果治疗后康复指导组、针灸组和管理组吞咽障碍改善总有效率分别为48.1%、77.4%和87.6%,针灸组、管理组与康复指导组比较差异有统计学意义(P<0.01);治疗后康复指导组、针灸组和管理组吸入性肺炎发生率分别为33.3%、19.4%和9.4%,管理组与针灸组、康复指导组比较差异有统计学意义(P<0.01)。结论发生急性脑卒中后,应关注和及早进行吞咽障碍的管理,通过干预,尽可能地改善患者的吞咽功能,减少吸入性肺炎的发生。OBJECTIVE To explore the prevention of aspiration pneumonia in patients of swallowing disorders after stroke through the early dysphagia management, in order to provide a new direction for clinical treatment. METHODS The acute stroke patients were evaluated their swallowing function by clinical assessment, and determined the severity of potential loss with diagnosis-treatment instrument of swallowing-speech. Ninety patients with different degrees of dysphagia were divided into rehabilitation instructing group （RIG）（n = 27）, acupuncture group （AG） （n = 31 ） and management group （MG） （n = 32 ）, who receiverd correspondingly conventional drug therapy. The RIG was only to guide the rehabilitation. The AG was on the basis of the guidance group, combined with acupuncture. The MG was on the granting of early dysphagia management. Three groups of patients were observed after 4 weeks the incidence of aspiration pneumonia and swallowing functional recovery. RESULTS After treatment the total efficiency rate of dysphagia improvement in RIG, AG and MG was 48. 1%, 77.4% and 87.6%, and there was significant statistics difference between AG and MG with RIG（P〈0.01） ; and the incidence of aspiration pneumonia was 33.3%, 19.4% and 9.4% in MG, AG and RIG groups, respectivly, and there was significant statistics difference between MG with RIG and AG（P〈0.01）. CONCLUSIONS Early dysphagia management can improve swallowing function in patients with acute stroke to reduce the incidence of aspiration pneumonia.

关 键 词：脑卒中 吞咽障碍 吸入性肺炎 预防 脑卒中 吞咽障碍 吸入性肺炎 预防 

分 类 号：R181.32[医药卫生—流行病学]