改良容积-黏度吞咽测试在脑卒中吞咽障碍患者鼻饲管拔管时机中的应用  

Application of volume viscosity swallowing test-Chinese version in the extubation time of nasogastric tube in stroke patients with dysphagia

作　　者：仲晓娟 何丽琴 ZHONG Xiao-juan;HE Li-qin(Department of Rehabilitation,Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou 215101,Jiangsu,China)

机构地区：[1]苏州市中西医结合医院康复科,江苏苏州215101

出　　处：《广东医学》2022年第10期1301-1306,共6页Guangdong Medical Journal

基　　金：苏州市中西医结合医院资助项目(YJ2020009)。

摘　　要：目的探究改良容积-黏度吞咽测试(volume viscosity swallowing test-Chinese version,VVST-CV)在脑卒中(cerebral stroke,CS)吞咽障碍患者鼻饲管拔管时机中的应用价值。方法选取收治的CS并发吞咽障碍并留置鼻饲管患者100例,采用随机数字表法分为对照组和观察组,各50例。对照组以洼田饮水试验(water swallowing test,WST)判断鼻饲管拔管时机,观察组以VVST-CV判断拔管时机。比较两组患者置管前与吞咽造影检查(video fluoroscopic swallowing study,VFSS)的一致性;比较两组患者置管前及拔管后吞咽功能;比较两组患者拔管前及出院时血清营养学指标及生活质量;比较两组患者拔管后并发症发生率及置管时间。结果VVST-CV与VFSS两种方法间一致性较WST与VFSS间高(Kappa=0.78 vs 0.24)。观察组拔管后功能性经口摄食量表(function oral intake sccale,FOIS)评分高于对照组(P<0.05);出院时,观察组血清白蛋白(albumin,Alb)、转铁蛋白(transferrin,TRF)、前白蛋白(prealbumin,PA)和心理功能、躯体功能、社会功能、物质生活状态评分及生活质量综合评定问卷(general quality of life inventory,GQOLI-74)总分高于对照组(P<0.05)。观察组患者拔管后吸入性肺炎、鼻饲管复插、营养不良发生率及置管时间明显低于对照组患者(P<0.05)。结论与WST相比,VVST-CV可更有效地确定适宜CS吞咽障碍患者拔管时机,更好地改善患者营养状态及生活质量,降低患者并发症及置管时间,安全性较高。Objective To evaluatethe application of volume viscosity swallowing test-Chinese version(VVST-CV)in the timing of nasogastric tube extubation in cerebral stroke(CS)patients with dysphagia.Methods A total of 100 patients with CS complicated with dysphagia and indwelling nasogastric tube were selected and divided into control group and observation group by random number table method,with 50 cases in each group.In the control group,the timing of tube extubation was determined by water swallowing test(WST)and in the observation group,the timing of tube extubation was determined by VVST-CV.The consistency of video fluoroscopic swallowing study(VFSS)before catheterization was compared between the two groups.The swallowing function before and after catheterization was compared between the two groups.Serum nutritive indexes and qualities of life before extubation and at discharge were compared between the two groups.The incidences of complications after extubation and catheterization time were compared between the two groups.Results The consistency between VVST-CV and VFSS was higher than that between WST and VFSS(Kappa=0.78 vs.0.24).Function oral intake scale(FOIS)score in the observation group was significantly higher than that in the control group(P<0.05).At discharge,the total scores of serum albumin(Alb),transferrin(TRF),prealbumin(PA),psychological function,physical function,social function,material life status and the total score of General Quality of Life Inventory(GQOLI-74)in the observation group were significantly higher than those in the control group(P<0.05).The incidences of aspiration pneumonia,reinsertion of nasogastric tube,malnutrition and catheterization time in observation group were significantly lower than those in control group(P<0.05).Conclusion Compared with WST,VVST-CV can more effectively determine the timing of extubation for patients with CS dysphagia,improve the nutritional status and quality of life of patients,and reduce the complications and catheterization time of patients,with high safe

关 键 词：改良容积-黏度吞咽测试 脑卒中 吞咽障碍 洼田饮水试验 鼻饲管 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R447[医药卫生—临床医学]