早期吞咽训练对急性脑卒中气管切开患者拔管成功率的影响探讨  

The influence of early swallowing training on extubation success rate in patients with acute stroke undergoing tracheotomy

作　　者：梁莉莉[1] 李林[1] 黄营湘 陈灿琼 LIANG Li-li;LI Lin;HUANG Ying-xiang(Department of Rehabilitation Medicine,Zhongshan People's Hospital,Zhongshan 528400,China)

机构地区：[1]广东省中山市人民医院康复医学科,528400

出　　处：《中国实用医药》2024年第14期173-177,共5页China Practical Medicine

摘　　要：目的探究早期吞咽训练对急性脑卒中气管切开患者拔管成功率的影响。方法34例急性脑卒中气管切开患者,按照随机数字表法分为常规治疗组和吞咽训练组,每组17例。常规治疗组进行常规治疗(脱水药物、神经保护剂、改善脑循环药物、化痰、维持内环境稳定等药物)以及常规护理(气道湿化、吸痰及每2小时翻身扣背等),吞咽训练组在常规治疗组基础上加用早期吞咽功能训练。比较两组一次拔管成功率、临床肺部感染评分(CPIS)、留管时间以及吞咽功能评分。结果吞咽训练组一次拔管成功率100.00%高于常规治疗组的70.59%,差异具有统计学意义(P<0.05)。治疗后,常规治疗组与吞咽训练组临床肺部感染评分均低于治疗前,且吞咽训练组临床肺部感染评分(2.24±0.43)分低于常规治疗组的(4.76±0.66)分,差异具有统计学意义(P<0.05)。吞咽训练组留管时间(28.12±12.18)d短于常规治疗组的(36.82±10.49)d,差异具有统计学意义(P<0.05)。治疗后,两组患者吞咽功能评分均低于治疗前,且吞咽训练组吞咽功能评分(2.47±1.17)分低于常规治疗组的(4.35±0.78)分,差异具有统计学意义(P<0.05)。结论急性脑卒中气管切开患者早期进行吞咽训练,可显著改善患者吞咽功能,提高一次性拔管成功率,降低肺炎发生率,缩短留管时间,最终提高患者生活质量,值得临床广泛推广应用。Objective To explore the influence of early swallowing training on extubation success rate in patients with acute stroke undergoing tracheotomy.Methods 34 patients with acute stroke undergoing tracheotomy were divided into a conventional treatment group and a swallowing training group according to random numerical table,with 17 cases in each group.The conventional treatment group received routine treatment(dehydration drugs,neuroprotective agents,drugs to improve cerebral circulation,reduce phlegm,maintain internal environment stability,etc)and routine nursing(airway humidification,suction,turning over and buckling back every 2 hours,etc),and the swallowing training group received early swallowing training on the basis of conventional treatment group.The success rate of one-time extubation,clinical pulmonary infection score(CPIS),duration of tube retention and swallowing function were compared between the two groups.Results The success rate of one-time extubation in the swallowing training group was 100.00%,which was higher than 70.59%in the conventional treatment group,and the difference was statistically significant(P<0.05).After treatment,the clinical pulmonary infection score of the conventional treatment group and the swallowing training group were lower than those before treatment;the clinical pulmonary infection score of the swallowing training group was(2.24±0.43)points,which was lower than(4.76±0.66)points of the conventional treatment group;the difference was statistically significant(P<0.05).The duration of tube retention was(28.12±12.18)d in the swallowing training group,which was shorter than(36.82±10.49)d in the conventional treatment group,and the difference was statistically significant(P<0.05).After treatment,the score of swallowing function in both groups were lower than that before treatment;the score of swallowing function was(2.47±1.17)points in the swallowing training group,which was lower than(4.35±0.78)points in the conventional treatment group;the difference was statistically signif

关 键 词：吞咽训练 吞咽障碍 气管切开 急性脑卒中 肺部感染 拔管 

分 类 号：R743.3[医药卫生—神经病学与精神病学]