软管喉镜吞咽功能评估对脑卒中患者临床功能结局的影响  

Early endoscopic evaluation of swallowing improves the functional outcome for stroke survivors

作　　者：郑凯 任彩丽[1,2] 徐新蕾 陈萍[1,2] 尤莉 方红群 Zheng Kai;Ren Caili;Xu Xinlei;Chen Ping;You Li;Fang Hongqun(Department of Neurorehabilitation,Wuxi Tongren Rehabilitation Hospital,Wuxi 214000,China;The Afliated Wuxi Mental Health Center of Nanjing Medical University,Wuxi 214000,China)

机构地区：[1]江苏省无锡市同仁康复医院神经康复科,无锡214000 [2]南京医科大学附属无锡市精神卫生中心,无锡214000

出　　处：《中华物理医学与康复杂志》2021年第12期1060-1064,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：无锡市太湖人才计划项目(WXTT P2020008);无锡市"双百"中青年医疗卫生拔尖人才项目。

摘　　要：目的观察软管喉镜吞咽功能评估(FEES)对亚急性期脑卒中患者临床功能结局的影响。方法对52例行FEES评估和51例未行FEES评估的脑卒中患者(分别纳入FEES组和对照组)进行回顾性病例对照研究,2组患者分别在FEES评估后或改良容积-黏度吞咽测试(V-VST)评估后根据结果进行吞咽功能训练和摄食训练。首要结局观察指标为肺炎发生率,次要结局观察指标包括鼻饲管拔除率、留置鼻饲管时间、功能性经口摄食评估(FOIS)分级、出院时饮食方式、住院时间等。结果与对照组比较,FEES组肺炎发生率明显降低(7.7%vs.39.2%,P<0.001),鼻饲管拔除率明显升高(75.0%vs.41.0%,P=0.002),FOIS分级明显改善(χ^(2)=9.868,P=0.001),出院时可尝试部分经口进食和完全经口进食患者百分比均明显增加(15.4%vs.13.7%,P=0.030;78.8%vs.54.9%,P=0.001)。通过多元Logistic回归分析发现,FEES组患者发病后到首次FEES检查间隔时间越长,其患肺炎的风险越大(P=0.023)。结论脑卒中亚急性期患者及早进行FEES检查能降低肺炎发生率,提高鼻饲管拔除率及吞咽功能,改善患者临床功能结局。Objective To observe any effect of endoscopic evaluation of swallowing(FEES)on the functional outcomes of post-stroke patients in the subacute phase.Methods A retrospective case-control study was conducted of 52 patients who had received an FEES assessment(the FEES group)and 51 who had not(the control group).Both groups received swallowing rehabilitation and intake training based on the results of the FEES assessment and those of a modified volume-viscosity swallowing test.The primary outcome indicator was the incidence of pneumonia.Secondary outcome indicators were the rate of removal of the nasal feeding tube,the length of indwelling of the nasal feeding tube,functional oral intake assessment scale(FOIS)scores,eating technique at discharge,and the length of hospital stay.Results Compared with the control group,the incidence of pneumonia in the FEES group was significantly lower(7.7%vs.39.2%).The removal rate of the nasal feeding tube was significantly greater(75.0%vs.41.0%).The FEES group showed a significant improvement in its average FOIS score.And the proportion of patients who could try partial oral eating or complete oral eating at discharge was significantly higher in the FEES group.Regression analysis indicated that the risk of pneumonia in the FEES group was positively related to the time from onset to the first FEES examination.Conclusion Early FEES examination after a stroke could reduce the incidence of pneumonia,increase chances of removing the nasal feeding tube and improve the swallowing function and outcome of stroke survivors.

关 键 词：软管喉镜吞咽功能评估 脑卒中 肺炎 临床功能结局 

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]