成人脑卒中患者吞咽障碍管理的证据总结
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摘要
目的遴选成人脑卒中患者吞咽障碍管理的最佳证据,提高管理效果。方法计算机检索BMJ最佳临床实践、Up to Date、Cochrane图书馆、美国指南网、JBI证据总结数据库、加拿大安大略注册护士网、CINAHL数据库、PubMed、国际指南协作网、中国临床指南文库、中国知网和中国生物医学文献数据库有关成人脑卒中患者吞咽障碍管理证据。采用临床指南研究与评价系统、2014版JBI证据预分级及推荐级别系统分别对各类研究进行文献质量评价及证据级别评定。结果共纳入21篇文献,遴选出具备临床适用性证据15条,涉及吞咽困难的识别、筛查、治疗、给药、营养支持及口腔护理等方面。结论本研究遴选的最佳证据,可应用于成人脑卒中患者吞咽障碍管理实践中;应用前需评估证据的促进和阻碍因素、患者意愿及偏好等,以选择个体适用证据。
Objective To summarize the available best evidences on management of post-stroke dysphagia among adult patients, and to help improve effect of management.Methods We searched the such databases as BMJ best practice, up to date, Cochrane Libra-ry, National Guideline Clearing house, Joanna Briggs Institute Library, RANO, CINAHL, PubMed, GIN, CGN, CNKI and CBM, to collect all the evidence regarding management of post-stroke dysphagia among adult patients. Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ) was used to appraised the evidence, and the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation(2014) were used to rate the evidence.Results A total of 15 pieces of evidence feasible and applicable in clinical context were summarized from 21 publications, covering such aspects as swallowing identification, screening, treatment, drug delivery principles, nutritional support and oral care.Conclusion The best evidence selected in this study can be applied in the management of dysphagia in adult stroke patients. Before application of the evidence in clinical context, it is necessary to consider the facilitators and barriers, and patients′ willingness and preferences, and select individual specific evidence.
Objective To summarize the available best evidences on management of post-stroke dysphagia among adult patients, and to help improve effect of management.Methods We searched the such databases as BMJ best practice, up to date, Cochrane Libra-ry, National Guideline Clearing house, Joanna Briggs Institute Library, RANO, CINAHL, PubMed, GIN, CGN, CNKI and CBM, to collect all the evidence regarding management of post-stroke dysphagia among adult patients. Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ) was used to appraised the evidence, and the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation(2014) were used to rate the evidence.Results A total of 15 pieces of evidence feasible and applicable in clinical context were summarized from 21 publications, covering such aspects as swallowing identification, screening, treatment, drug delivery principles, nutritional support and oral care.Conclusion The best evidence selected in this study can be applied in the management of dysphagia in adult stroke patients. Before application of the evidence in clinical context, it is necessary to consider the facilitators and barriers, and patients′ willingness and preferences, and select individual specific evidence.
引文
[1] 孙智成,江小荣,陈景敏.脑卒中后吞咽障碍治疗进展[J].实用中医药杂志,2017,33(3):336-339.
[2] Huang K L, Liu T Y, Huang Y C, et al.Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy[J].J Stroke Cerebrovasc Dis,2014,23(10):2547-2553.
[3] 高尚谦,王芳,姜雨婷,等.卒中后吞咽困难识别与管理循证指南的系统评价[J].中国护理管理,2016,16(5):596-601.
[4] 韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
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[7] Hebert D, Lindsay M P, Mcintyre A, et al.Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015[J].Int J Stroke,2016,11(4):459-484.
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[10] Lizarondo L.Post stroke dysphagia: nursing management[EB/OL].(2017-06-28)[2018-06-22].https://www.jbisumari.org/.
[11] Nguyen D H.Dysphagia in stroke: neuromuscular electrical stimulation[EB/OL].(2017-08-09)[2018-04-22].https://www.jbisumari.org/.
[12] Anonymous L.Dysphagia (Adults):outcomes measurement and screening[EB/OL].(2017-02-24)[2018-04-22].https://www.jbisumari.org/.
[13] Stephenson M.Oral medication:swallowing difficulties (dysphagia)[EB/OL].(2017-10-06)[2018-04-22].https://www.jbisumari.org/.
[14] Hines S, Wallace K, Crowe L, et al.Identification and nursing management of dysphagia in individuals with acute neurological impairment (update)[J].Int J Evid Based Healthc,2011,9(2):148-150.
[15] HSFO Ontario.Stroke assessment across the continuum of care[EB/OL].[2018-04-22].http://hdl.handle.net/10755/347367
[16] Hammond C A S, Goldstein L B.Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines[J].Chest,2006,129(Suppl 1):154S-168S.
[17] National Clinical Guideline Center.Stroke rehabilitation: long-term rehabilitation after stroke[J].Clini Med,2015,15(5):461.
[18] 丁里,王拥军,王少石,等.卒中患者吞咽障碍和营养管理的中国专家共识(2013版)[J].中国卒中杂志,2013,8(12):973-983.
[19] Wilson R D, Howe E C.A cost-effectiveness analysis of screening methods for dysphagia after stroke[J].PMR,2012,4(4):273-282.
[20] Gomes C A Jr, Andriolo R B, Bennett C, et al.Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances[J].Cochrane Database Syst Rev,2015(5):CD008096.
[21] Hines S, Kynoch K, Munday J.Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: a systematic review update[J].J Neurosci Nurs,2016,48(4):215-223.
[22] Long Y B, Wu X P.A meta-analysis of the efficacy of acupuncture in treating dysphagia in patients with a stroke[J].Acupunct Med, 2012, 30(4):291-297.
[23] Chuang C H.Accuracy of water swallow test for dysphagia with stroke: a meta-analysis[J].J Nurs Healt Res,2015,11(2):161-169.
[24] Pisegna J M, Kaneoka A, Pearson W G Jr, et al.Effects of non-invasive brain stimulation on post-stroke dysphagia:a systematic review and meta-analysis of randomized controlled trials[J].Clin Neurophysiol,2016,127(1):956-958.
[25] Liao X, Xing G, Guo Z, et al.Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke:a systematic review and meta-analysis[J].Clin Rehabil,2017,31(3):289-298.
[26] Ye Q, Xie Y, Shi J, et al.Systematic review on acupuncture for treatment of dysphagia after stroke[J].Evid Based Complement Alternat Med,2017:6421852.
[27] Poorjavad M, Jalaie S.Systemic review on highly qualified screening tests for swallowing disorders following stroke:validity and reliability issues[J].J Res in Med Sci,2014,19(8):776-785.
[28] Park Y H, Bang H L, Han H R, et al.Dysphagia screening measures for use in nursing homes: a syste-matic review[J].J Korean Acad Nurs,2015,45(1):1-13.
[29] Daniels S K, Anderson J A, Willson P C.Valid items for screening dysphagia risk in patients with stroke a systematic review[J].Stroke,2012,43(3):892-897.
[30] O′Horo J C, Rogus-pulia N, Garcia-arguello L, et al.Bedside diagnosis of dysphagia:a systematic review[J].J Hosp Med,2015,10(4):256-265.
[31] Chen P C, Chuang C H, Leong C P, et al.Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients[J].J Adv Nurs,2016,72(11):2575-2586.
[32] Lagarde M L, Kamalski D M, van den Engel-Hoek L, et al.The reliability and validity of cervical auscultation in the diagnosis of dysphagia: a systematic review[J].Clin Rehabil,2016,30(2):199-207.
[33] Winstein C J, Stein J, Arena R, et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2016,47(6):e98.
[34] Huang K L, Liu T Y, Huang Y C, et al.Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy[J].J Stroke Cerebrovasc Dis,2014,23(10):2547-2553.
[35] Mercovich N, Kyle G J, Naunton M.Safe to crush? A pilot study into solid dosage form modification in aged care[J].Australas J Ageing,2014,33(3):180-184.
[36] Serrano Santos J M, Poland F, Wright D, et al.Medicines administration for residents with dysphagia in care homes:a small scale observational study to improve practice[J].Int J Pharm,2016,512(2):416-421.
[37] Van W S, Wijma L, Beerden T, et al.Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study[J].BMJ Open,2016,6(8):e012286.
[38] Dennis M S, Lewis S C, Warlow C.Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial[J].Lancet,2005,365(9641):764-772.
[39] 黄辉,黄海燕,喻姣花,等.ICU成人失禁相关性皮炎护理证据应用审查及障碍分析[J].护理学杂志,2018,33(14):105-108.
[40] 龙成连,刘丽萍,江锦芳,等.鼻咽肿瘤患者失禁相关性皮炎防护策略的循证实践[J].护理学杂志,2017,32(11):87-89.
[2] Huang K L, Liu T Y, Huang Y C, et al.Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy[J].J Stroke Cerebrovasc Dis,2014,23(10):2547-2553.
[3] 高尚谦,王芳,姜雨婷,等.卒中后吞咽困难识别与管理循证指南的系统评价[J].中国护理管理,2016,16(5):596-601.
[4] 韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[5] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[6] Charous S J.Assessment of dysphagia[EB/OL].(2017-11-01)[2018-04-22].http://xueshu.baidu.com/s?wd=paperuri%3A%28d2bc6dd65ea95d3788eb2e5e05a4065a%29&filter=sc_long_sign&sc_ks_para=q%3DAssessment%20of%20dysphagia&sc_us=12014745154022571183&tn=SE_bai-duxueshu_c1gjeupa&ie=utf-8.
[7] Hebert D, Lindsay M P, Mcintyre A, et al.Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015[J].Int J Stroke,2016,11(4):459-484.
[8] Lizarondo L.Post-stroke dysphagia:oral motor exercise[EB/OL].(2016-07-26)[2018-04-22].https://www.jbisumari.org/.
[9] Mann E.Post stroke dysphagia:risk assessment[EB/OL].(2017-01-29)[2018-04-22].https://www.jbisumari.org/.
[10] Lizarondo L.Post stroke dysphagia: nursing management[EB/OL].(2017-06-28)[2018-06-22].https://www.jbisumari.org/.
[11] Nguyen D H.Dysphagia in stroke: neuromuscular electrical stimulation[EB/OL].(2017-08-09)[2018-04-22].https://www.jbisumari.org/.
[12] Anonymous L.Dysphagia (Adults):outcomes measurement and screening[EB/OL].(2017-02-24)[2018-04-22].https://www.jbisumari.org/.
[13] Stephenson M.Oral medication:swallowing difficulties (dysphagia)[EB/OL].(2017-10-06)[2018-04-22].https://www.jbisumari.org/.
[14] Hines S, Wallace K, Crowe L, et al.Identification and nursing management of dysphagia in individuals with acute neurological impairment (update)[J].Int J Evid Based Healthc,2011,9(2):148-150.
[15] HSFO Ontario.Stroke assessment across the continuum of care[EB/OL].[2018-04-22].http://hdl.handle.net/10755/347367
[16] Hammond C A S, Goldstein L B.Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines[J].Chest,2006,129(Suppl 1):154S-168S.
[17] National Clinical Guideline Center.Stroke rehabilitation: long-term rehabilitation after stroke[J].Clini Med,2015,15(5):461.
[18] 丁里,王拥军,王少石,等.卒中患者吞咽障碍和营养管理的中国专家共识(2013版)[J].中国卒中杂志,2013,8(12):973-983.
[19] Wilson R D, Howe E C.A cost-effectiveness analysis of screening methods for dysphagia after stroke[J].PMR,2012,4(4):273-282.
[20] Gomes C A Jr, Andriolo R B, Bennett C, et al.Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances[J].Cochrane Database Syst Rev,2015(5):CD008096.
[21] Hines S, Kynoch K, Munday J.Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: a systematic review update[J].J Neurosci Nurs,2016,48(4):215-223.
[22] Long Y B, Wu X P.A meta-analysis of the efficacy of acupuncture in treating dysphagia in patients with a stroke[J].Acupunct Med, 2012, 30(4):291-297.
[23] Chuang C H.Accuracy of water swallow test for dysphagia with stroke: a meta-analysis[J].J Nurs Healt Res,2015,11(2):161-169.
[24] Pisegna J M, Kaneoka A, Pearson W G Jr, et al.Effects of non-invasive brain stimulation on post-stroke dysphagia:a systematic review and meta-analysis of randomized controlled trials[J].Clin Neurophysiol,2016,127(1):956-958.
[25] Liao X, Xing G, Guo Z, et al.Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke:a systematic review and meta-analysis[J].Clin Rehabil,2017,31(3):289-298.
[26] Ye Q, Xie Y, Shi J, et al.Systematic review on acupuncture for treatment of dysphagia after stroke[J].Evid Based Complement Alternat Med,2017:6421852.
[27] Poorjavad M, Jalaie S.Systemic review on highly qualified screening tests for swallowing disorders following stroke:validity and reliability issues[J].J Res in Med Sci,2014,19(8):776-785.
[28] Park Y H, Bang H L, Han H R, et al.Dysphagia screening measures for use in nursing homes: a syste-matic review[J].J Korean Acad Nurs,2015,45(1):1-13.
[29] Daniels S K, Anderson J A, Willson P C.Valid items for screening dysphagia risk in patients with stroke a systematic review[J].Stroke,2012,43(3):892-897.
[30] O′Horo J C, Rogus-pulia N, Garcia-arguello L, et al.Bedside diagnosis of dysphagia:a systematic review[J].J Hosp Med,2015,10(4):256-265.
[31] Chen P C, Chuang C H, Leong C P, et al.Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients[J].J Adv Nurs,2016,72(11):2575-2586.
[32] Lagarde M L, Kamalski D M, van den Engel-Hoek L, et al.The reliability and validity of cervical auscultation in the diagnosis of dysphagia: a systematic review[J].Clin Rehabil,2016,30(2):199-207.
[33] Winstein C J, Stein J, Arena R, et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2016,47(6):e98.
[34] Huang K L, Liu T Y, Huang Y C, et al.Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy[J].J Stroke Cerebrovasc Dis,2014,23(10):2547-2553.
[35] Mercovich N, Kyle G J, Naunton M.Safe to crush? A pilot study into solid dosage form modification in aged care[J].Australas J Ageing,2014,33(3):180-184.
[36] Serrano Santos J M, Poland F, Wright D, et al.Medicines administration for residents with dysphagia in care homes:a small scale observational study to improve practice[J].Int J Pharm,2016,512(2):416-421.
[37] Van W S, Wijma L, Beerden T, et al.Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study[J].BMJ Open,2016,6(8):e012286.
[38] Dennis M S, Lewis S C, Warlow C.Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial[J].Lancet,2005,365(9641):764-772.
[39] 黄辉,黄海燕,喻姣花,等.ICU成人失禁相关性皮炎护理证据应用审查及障碍分析[J].护理学杂志,2018,33(14):105-108.
[40] 龙成连,刘丽萍,江锦芳,等.鼻咽肿瘤患者失禁相关性皮炎防护策略的循证实践[J].护理学杂志,2017,32(11):87-89.