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《Journal of the American Medical Directors Association》2022,23(8):1354-1359.e2
ObjectivesDysphagia is prevalent in older adults with dementia, particularly in the acute care setting. The objective of this study was to use an innovative approach to extract a more representative sample of patients with dysphagia from the electronic health record (EHR) to determine patient characteristics, hospital practices, and outcomes associated with dysphagia in hospitalized persons with dementia.DesignA retrospective study of hospitalized adults (aged ≥65 years) with dementia was conducted in 7 hospitals across the greater New York metropolitan area.Setting and ParticipantsData were obtained from the inpatient EHR with the following inclusion criteria: age ≥65 years; admitted to one of 7 health system hospitals between January 1, 2019, and December 31, 2019; and documented past medical diagnosis of dementia (based on International Classification of Diseases, Ninth Revision).MethodsA diagnosis of dysphagia was defined as nurse documentation of a positive bedside swallow screening, nurse documentation of “difficulty swallowing” as reason for not performing bedside swallow screening, and physician documentation of a dysphagia diagnosis.ResultsOf adults with dementia (N = 8637), the average age was 84.5 years, 61.6% were female, and 18.1% were Black and 9.3% Hispanic. Dysphagia was identified in 41.8% (n = 3610). In multivariable models, dysphagia was associated with invasive mechanical ventilation [odds ratio (OR) 4.53, 95% CI 3.55-5.78], delirium (OR 1.53, 95% CI 1.40-1.68), increased length of stay (B = 3.29, 95% CI 2.98-3.60), and mortality (OR 4.44, 95% CI 3.54-5.55).Conclusions and ImplicationsGiven its high prevalence, underrecognition, and associated poor outcomes, improving large-scale dysphagia identification can impact clinical care and advance research in hospitalized persons with dementia. 相似文献
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目的:观察“风三针”针刺疗法在治疗中风后吞咽障碍的临床疗效。方法:随机收集中风后吞咽障碍患者60例,按照不同的治疗方法分为对照组和治疗组各30例。两组均先进行吞咽康复训练,后治疗组予风三针针刺治疗,观察两组治疗后洼田饮水试验评分,VFSS吞咽难度评分,并进行对比分析其临床疗效。结果:对照组及治疗组在治疗4个疗程后,治疗组总有效率93.33%高于对照组70.00%(P<0.05); 两组洼田饮水试验评分治疗后均低于治疗前(P<0.05),治疗组的评分低于对照组(P<0.05); 两组的VFSS吞咽难度评分治疗后均高于治疗前(P<0.05); 治疗组的VFSS难度评分高于对照组(P<0.05)。结论:“风三针”针刺疗法在治疗中风吞咽障碍中临床疗效确切。 相似文献
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《Surgery (Oxford)》2021,39(9):569-576
Disorders of swallowing are very common and, when looked for, occur regularly in most branches of surgery. Dysphagia is often not the patient’s presenting complaint and can be easily missed. The consequences of missed or delayed diagnosis of dysphagia can be insidious but profound and, in some cases, fatal. The investigation and treatment of these patients is normally highly multidisciplinary, potentially involving gastroenterology, general surgery, otolaryngology, acute medicine, stroke medicine, paediatrics, speech and language therapy (SLT) and dietitians. While this article is aimed at surgeons and will thus concentrate mostly on those conditions seen by surgeons, it must be remembered that the most common cause of dysphagia is a neurological disturbance and is managed by physicians and SLT. That said, the incidence of these conditions rises with age, as does the incidence of many surgically treatable conditions. It is therefore common to assess a patient with a known neurological condition for the presence of a second pathology affecting their swallow. A basic knowledge of non-surgical conditions is therefore useful. 相似文献
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目的 观察电针结合导管球囊扩张术治疗脑卒中后环咽肌失弛缓所致吞咽障碍的临床疗效。方法 将60例患者随机分为观察组和对照组,每组30例。对照组予以导管球囊扩张术治疗,观察组在对照组的基础上加用电针,取穴廉泉、夹廉泉、翳风、风池,予以连续波,频率2 Hz。两组患者每天治疗1次,每周6 d,连续治疗4周。采用洼田饮水试验、标准吞咽功能评价量表(standardized swallowing assessment,SSA)评价患者吞咽功能,并观察“声嘶语謇”等9个症状积分,根据洼田饮水试验分级变化判定临床疗效。结果 治疗4周后,两组洼田饮水试验评分、SSA评分、症状积分均较治疗前显著降低(P<0.05),且观察组各项评分降低程度明显大于对照组(P<0.05);观察组临床疗效显著优于对照组(P<0.05)。结论 电针结合导管球囊扩张术可减轻吞咽相关的临床症状,提高总体疗效。 相似文献
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目的 观察BTX-A注射唾液腺改善脑卒中流涎症的临床疗效和安全性。方法 收集福建中医药大学附属康复医院住院的30例脑卒中后流涎的患者,按照随机数字表法随机分为治疗组15例和对照组15例。两组均给予常规吞咽康复训练12周,治疗组在常规吞咽康复训练基础上予超声引导下100U BTX-A双侧腮腺和颌下腺分别注射35U及15U。采用流涎频率评分、教师流涎分级法(TDS)、Frenchay构音障碍评定法中关于流涎的分级标准于BTX-A治疗前、治疗12周后评估各组患者的流涎程度。结果 BTX-A注射唾液腺12周后,治疗组的流涎频率评分总有效率明显高于对照组的(P<0.05);治疗组TDS评分总有效率明显高于对照组的(P<0.05);治疗组Frenchay流涎评分总有效率明显高于对照组(P<0.05)。结论 常规吞咽训练配合BTX-A注射唾液腺明显改善脑卒中吞咽障碍患者的流涎症状,是一种安全有效的治疗方法及副作用少,对改善患者形象及生活自信建立帮助巨大,值得临床上推广及应用。 相似文献
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吞咽障碍是脑卒中后常见的并发症之一,目前针药结合治疗本病具有较好的临床疗效。综述近年来针药结合治疗脑卒中后假性球麻痹吞咽障碍的文献,以期对本病未来的临床工作有些许启发。目前以针药结合为主治疗本病的方法包括毫针结合内服中药、穴位贴敷、穴位注射、中药穴位离子导入以及毫针与中药以其他形式的结合,包括中药药棒、药枕、中药点舌、氧驱雾化吸入、灌肠等。针药结合治疗本病具有同效相须、异效互补、反效制约的治疗特点,也存在不少问题亟待解决。 相似文献
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Laura L. Pitts Lynn Rogers Xue Wang Mariana M. Bahia Leora R. Cherney 《Topics in stroke rehabilitation》2020,27(4):241-250
ABSTRACT
Background
Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) directly facilitates lingual pressure generation. 相似文献10.