经容积黏度试验介导的早期摄食训练对急性脑卒中后留置胃管病人的影响
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摘要
[目的]探讨经容积黏度试验(V-VST)介导的早期摄食训练对急性脑卒中后留置胃管病人的影响。[方法]选择2017年8月—2018年8月收治的急性脑卒中病人50例,按照随机数字表法分为对照组和观察组25例,两组病人病情稳定后均接受早期吞咽功能训练,观察组在此基础上通过V-VST评估病人进食的性状和一口量后,进行早期的标准摄食训练。比较两组置胃管时间、拔管成功例数、吸入性肺炎发生率及住院时间。[结果]两组成功拔管率和吸入性肺炎发生率差异无统计学意义(P>0. 05),观察组置胃管时间和住院时间少于对照组(P<0. 05)。[结论]针对急性脑卒中后留置胃管病人早期采用经V-VST介导的摄食训练,可以缩短留置胃管时间和住院时间。
Objective:To investigate the effect of early stage ingestion exercise mediated by volume-viscosity swallow test(V-VST) on the time of extubation in patients with indwelling gastric tube after acute stroke.Methods:Fifty patients with acute stroke admitted the hospital from August 2017 to August 2018 were enrolled.According to the random number table method,they were divided into the control group and the observation group,25 cases in each group.After stable condition,both two groups received early-stage swallowing function training.The observation group assessed the traits and a dose of the patient's eating by V-VST and conducted early-stage standard ingestion exercise.The time of gastric tube placement,the number of successful extubation,both two group incidence of aspiration pneumonia,and the length of hospital stay were compared between the two groups.Results:There was no significant difference between the two groups in the successful extubation rate and the incidence of aspiration pneumonia(P>0.05).The length of gastric tube administration and hospital stay in the observation group were shorter than those in the control group(P<0.05).Conclusions:Conducting ingestion exercise mediated by V-VST on patients with indwelling gastric tube after acute stroke could shorten the length of indwelling gastric tube,and hospital say.
Objective:To investigate the effect of early stage ingestion exercise mediated by volume-viscosity swallow test(V-VST) on the time of extubation in patients with indwelling gastric tube after acute stroke.Methods:Fifty patients with acute stroke admitted the hospital from August 2017 to August 2018 were enrolled.According to the random number table method,they were divided into the control group and the observation group,25 cases in each group.After stable condition,both two groups received early-stage swallowing function training.The observation group assessed the traits and a dose of the patient's eating by V-VST and conducted early-stage standard ingestion exercise.The time of gastric tube placement,the number of successful extubation,both two group incidence of aspiration pneumonia,and the length of hospital stay were compared between the two groups.Results:There was no significant difference between the two groups in the successful extubation rate and the incidence of aspiration pneumonia(P>0.05).The length of gastric tube administration and hospital stay in the observation group were shorter than those in the control group(P<0.05).Conclusions:Conducting ingestion exercise mediated by V-VST on patients with indwelling gastric tube after acute stroke could shorten the length of indwelling gastric tube,and hospital say.
引文
[1]Aron.Correction to:2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e138.
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[7]Sister Kenny Institute Staff.Dysphsgia[M].Minneapolis:Sister Kenny Institute Rehabilitation Publication,1986:15-41.
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[12]朱美红,时美芳,万里红,等.吞咽-摄食管理预防脑卒中吞咽障碍患者相关性肺炎的研究[J].中华护理杂志,2016,51(3):294-298.
[13]李洪丽,苗善智,杨坚,等.脑卒中伴吞咽障碍患者不同训练方法的疗效观察[J].中国医药导报,2016,13(28):44-47.
[14]杨丹,魏海棠,彭涛,等.认知训练结合吞咽实时电刺激对脑卒中后吞咽障碍的疗效[J].中国康复理论与实践,2015,21(8):939-942.
[15]STEELE C M,ALSANEI W A,AYANIKALATH S,et al.The influence of food texture and liquid consistency modification on swallowing physiology and function:a systematic review[J].Dysphagia,2015,30(1):2-26.
[16]ROGER N,NATàLIA V,PERE C,et al.Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia:white paper by the European Society for Swallowing Disorders(ESSD)[J].Dysphagia,2016,31(2):232-249.
[17]中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J].中华物理医学与康复杂志,2017(12):881-892.
[2]SALAH G.Poor nutritional status on admission predicts poor outcomes after stroke:observational data from the food trial[J].Stroke,2003,34(6):1450-1456.
[3]ROWAT A.Enteral tube feeding for dysphagic stroke patients[J].Br J Nurs,2015,24(3):138-145.
[4]BEAVAN J.Update on management options for dysphagia after acute stroke[J].British Journal of Neuroscience Nursing,2015,11(Sup 2):10-19.
[5]DEPIPPO K L,HOLAS M A,REDING M J.Validation of the 3-oz water swallow test for aspiration following stroke[J].Archives of Neurology,1992,49(12):1259-1261.
[6]CLAV?P,ARREOLA V,ROMEA M,et al.Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration[J].Clinical Nutrition,2008,27(6):806-815.
[7]Sister Kenny Institute Staff.Dysphsgia[M].Minneapolis:Sister Kenny Institute Rehabilitation Publication,1986:15-41.
[8]DANTAS R O,KERN M K,MASSEY B T,et al.Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing[J].American Journal of Physiology,1990,258(1):675-681.
[9]ROFES L,ARREOLA V,MUKHERJEE R,et al.Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia[J].Neurogastroenterology&Motility the Official Journal of the European Gastrointestinal Motility Society,2014,26(9):1256-1265.
[10]SEO E J,BEAK H H,KIM J J.The effect of direct swallowing treatment on the swallowing function and quality of life of the stroke patient[J].JKIECS,2013,8(9):1413-1420.
[11]LANGMORE S E,PISEGNA J M.Efficacy of exercises to rehabilitate dysphagia:a critique of the literature[J].International Journal of Speech-Language Pathology,2015,17(3SI):222-229.
[12]朱美红,时美芳,万里红,等.吞咽-摄食管理预防脑卒中吞咽障碍患者相关性肺炎的研究[J].中华护理杂志,2016,51(3):294-298.
[13]李洪丽,苗善智,杨坚,等.脑卒中伴吞咽障碍患者不同训练方法的疗效观察[J].中国医药导报,2016,13(28):44-47.
[14]杨丹,魏海棠,彭涛,等.认知训练结合吞咽实时电刺激对脑卒中后吞咽障碍的疗效[J].中国康复理论与实践,2015,21(8):939-942.
[15]STEELE C M,ALSANEI W A,AYANIKALATH S,et al.The influence of food texture and liquid consistency modification on swallowing physiology and function:a systematic review[J].Dysphagia,2015,30(1):2-26.
[16]ROGER N,NATàLIA V,PERE C,et al.Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia:white paper by the European Society for Swallowing Disorders(ESSD)[J].Dysphagia,2016,31(2):232-249.
[17]中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J].中华物理医学与康复杂志,2017(12):881-892.