呼吸训练在吞咽障碍患者中应用效果的系统评价  

Application effects of respiratory training in patients with dysphagia: a systematic review

作　　者：王芳[1] 陈璐[1] 姚志清[2] 傅巧美[3] Wan Fang;Chen Lu;Yao Zhiqing;Fu Qiaomei(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Nursing Department,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China;Depart merit of Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008 [2]南京大学医学院附属口腔医院护理部,南京210008 [3]南京大学医学院附属鼓楼医院大外科,南京210008

出　　处：《中华现代护理杂志》2019年第7期844-848,共5页Chinese Journal of Modern Nursing

基　　金：江苏省青年医学人才项目(QNRC2016010).

摘　　要：目的系统评价呼吸训练对吞咽障碍患者吞咽功能和呼吸功能的影响,为吞咽障碍患者的康复护理提供参考意见。方法计算机检索PubMed、EMBASE、Web of Science、Cochrane Central Register of Controlled Trials、CINAHL、Physiotherapy Evidence Database、中国生物医学文献服务系统(CBM)、CNKI、万方数据库中关于吞咽障碍患者呼吸训练的随机对照试验,检索时限为建库至2018年4月 30 日,按Cochrane 协作网的系统评价方法筛选文献、评价纳入文献的质量,使用RevMan5.3 软件进行统计分析。结果最终共纳入9 篇文献,3 篇文献质量评价为A 级,其余为B 级。Meta 分析结果显示,与常规吞咽障碍护理相比,呼吸训练可以改善吞咽障碍患者洼田饮水试验吞咽功能评定结果[RR=1.33, 95%CI(1.17,1.53),P<0.01],提高用力肺活量(FVC)[MD=0.47,95%CI(0.11,0.82),P<0.01]、第1 秒用力呼气容积(FEV1)[MD=0.47,95%CI(0.20,0.74),P<0.01]、呼气峰值流速(PEF)[MD=1.00,95%CI (0.91,1.10),P<0.01],降低渗透-误吸量表(PAS)评分[MD=-1.05,95%CI(-1.70,-0.41),P<0.01]。结论与常规吞咽障碍护理相比,呼吸训练能够改善吞咽障碍患者洼田饮水试验吞咽功能评定结果,提高FVC、FEV1、PEF,降低PAS评分。但仍然需要大样本、多中心、高质量的随机对照试验对本研究结果予以验证。Objective To systematically review the respiratory training on swallowing function and respiratory function among patients with dysphagia so as to provide a reference for rehabilitation nursing of patients with dysphagia. Methods From establishing the database to 30th April 2018, we retrieved the randomized controlled trials( RCTs) on respiratory training of patients with dysphagia in PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Physiotherapy Evidence Database, Chinese BioMedical Literature Database( CBM), China National Knowledge Infrastructure( CNKI) and WanFang Data by computer. The literatures were screened and quality of the included literatures were evaluated according to the system evaluation method of the Cochrane collaboration. The RevMan5.3 was used to statistical analysis. Results A total of 9 literatures were included, and three of them were with the level A of literature quality and the rest were with the level B. Meta-analysis showed that compared with routine dysphagia nursing, respiratory training could improve the swallowing function evaluated by water swallow test[ RR=1.33, 95%CI (1.17, 1.53),P<0.01], forced vital capacity( FVC)[ MD =0.47, 95%C(I 0.11, 0.82),P<0.01], forced expiratory volume in one second( FEV1)[MD=0.47, 95%C(I 0.20,0.74),P<0.01], peak expiration flow( PEF)[MD=1.00, 95%C(I 0.91, 1.10),P<0.01]and reduce the score of penetration-aspiration scale( PAS)[ MD=-1.05, 95%CI(-1.70,-0.41),P<0.01]of patients with dysphagia. Conclusions Compared with routine dysphagia nursing, respiratory training could improve the swallowing function evaluated by water swallow test, FVC, FEV1, PEF and reduce the score of PAS of patients with dysphagia. However, the findings still need be validated by large sample, multicenter and high quality RCTs.

关 键 词：META分析 呼吸训练 吞咽障碍 呼吸功能 系统评价 

分 类 号：R473.74[医药卫生—护理学]