水凝胶摄食训练改善卒中后吞咽障碍患者吞咽功能疗效研究  

Efficacy Study on Training by Using Hydrogel to Improve Swallowing Function in Patients with Dysphagia after Stroke

作　　者：黄绍春[1] 徐建珍[1] 刘莉[1] 饶江[1] 仇海燕[1] 于灿萍 章洁[1] 李淑婕 HUANG Shaochun;XU Jianzhen;LIU Li;RAO Jiang;QIU Haiyan;YU Canping;ZHANG Jie;LI Shujie(The Affiliated Brain Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学附属脑科医院,江苏南京210029

出　　处：《康复学报》2021年第5期396-401,共6页Rehabilitation Medicine

基　　金：国家自然科学基金青年基金项目(81701675);南京市卫生科技发展专项资金项目(YKK18119)。

摘　　要：目的:探讨训练用水凝胶在卒中后吞咽障碍拔除鼻胃管前改善吞咽功能的临床疗效。方法:选择符合中华医学会神经病学分会制定的脑卒中诊断标准,并于2020年5—10月招募脑卒中后吞咽障碍留置鼻胃管且功能性经口摄食量表(FOIS)评级为1~3级的患者80例,根据随机数字表法分为观察组和对照组,每组各40例。2组除依据鼻胃管常规护理,进行常规吞咽康复治疗外,观察组在鼻饲状态下采用训练用水凝胶经口摄食训练,为期3周。分别在治疗前后采用FOIS评级法判定2组患者的吞咽功能,用渗漏误吸分级(PAS)评估2组治疗前后的渗漏误吸情况,用鼻胃管拔管率评价疗效。比较2组治疗前及治疗3周后FOIS、PAS和鼻胃管拔管率。结果:对照组治疗前后FOIS分级差异有统计学意义(χ^(2)=38.892,P<0.001),PAS差异无统计学意义(χ^(2)=11.987,P>0.05),对照组的鼻胃管拔管率25%;观察组治疗前后FOIS分级差异有统计学意义(χ^(2)=94.517,P<0.001),PAS差异有统计学意义(χ^(2)=80.936,P<0.001),观察组的鼻胃管拔管率100%;观察组治疗前后FOIS分级均值、PAS组间构成比、拔管率与对照组比较,差异均有统计学意义(FOIS分级:χ^(2)=86.176,P<0.001;PAS:χ^(2)=57.411,P<0.001;拔管率:χ^(2)=48,P<0.001)。结论:应用水凝胶经口摄食训练,可显著改善吞咽障碍患者吞咽功能,结合规范化进食过程管理,拔管率明显提升,有助于患者早日实现安全经口进食。Objective: To explore the clinical efficacy on training by using hydrogel to improve swallowing function in patients with dysphagia after stroke. Methods: In accordance with the diagnostic criteria of stroke established by Neurology Society of Chinese Medical Association, a total of 80 patients with dysphagia after stroke and Functional Oral Intake Scale(FOIS) with FOIS grade 1-3 were enrolled from May 2020 to October 2020. According to the random number table, they were randomly divided into observation group and control group, with 40 cases in each group. In addition to the routine swallowing rehabilitation treatment by the routine nasogastric tube treatment, the observation group was given oral feeding training of hydrogel under nasal feeding state for 3 weeks. Before and after treatment, the swallowing function of the two groups was determined by FOIS, the leakage aspiration was assessed by Penetration-Aspiration scale(PAS), and the efficacy was evaluated by the rate of nasogastric tube removal. The mean FOIS, PAS and the extubation rate of nasogastic tube were compared between the two groups before and after treatment. Results: There was statistically significant difference in FOIS grade in the control group before and after treatment(χ^(2)=38.892, P<0.001), while there was no statistically significant difference in PAS grade(χ^(2)=11.987, P>0.05). The extubation rate of nasogastic tube in the control group was 25%. The difference of FOIS and PAS grade in the observation group before and after treatment was statistically significant(χ^(2)=94.517, P<0.001), and the extubation rate of nasogastic tube in the observation group was 100%. There were statistically significant differences between the observation group and the control group before and after treatment in the mean FOIS grade, the composition ratio of PAS grade and the extubation rate(FOIS: χ^(2)=86.176, P<0.001;PAS: χ^(2)=57.411, P<0.001;Extraction rate: χ^(2)=48, P<0.001). Conclusion: The application of hydrogel in oral feeding training can sign

关 键 词：脑卒中 训练用水凝胶 吞咽功能 摄食训练 拔管率 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]