脑卒中早期康复治疗及护理进展

近年来 ,随着脑卒中治疗水平的提高 ,死亡率有所下降 ,但脑卒中后残疾病人却不断增加 ,因而 ,脑卒中后的早期康复越来越受到重视。所谓早期康复 ,是指病人在患脑卒中后只要生命体征稳定 ,神志清楚 ,神经系统症状不再恶化 ,4 8ｈ后即可进行的康复[1,2 ] 。现将我国早期康复的治疗及护理进展综述如下 :1　吞咽障碍的早期康复吞咽障碍是脑卒中的常见并发症 ,由于吞咽障碍 ,进食困难 ,可出现误吸 ,发生吸入性肺炎 ,严重者可因窒息而危及生命[3 ,4 ] 。黄丽欢等[5] 对 12 2例脑卒中患者的吞咽困难 ,在入院 2～ 7天内根据病情进行吞咽功能训练 :发…     

脑卒中合并假性球麻痹患者吞咽功能康复护理

吞咽障碍是脑卒中患者常见的症状，据统计，脑卒中急性期吞咽障碍的发生率为51％～73％。患者可因吞咽障碍出现误吸、误咽和窒息，发生吸人性气管炎、肺炎，严重者可因窒息危及生命；也可造成不同程度的进食困难，引起营养失调，影响患者的康复。     

脑卒中后吞咽障碍的护理研究进展

吞咽障碍是脑卒中常见的症状之一,50％脑卒中患者发病后伴有不同程度的吞咽障碍。轻者只有吞咽不畅感或出现误咽,重者因水和营养的摄取困难,患者生活质量低,不但影响患者的早期康复治疗,而且使患者的生命受到威胁。因此,吞咽障碍康复为当务之急,必须尽早改善其摄食一吞咽功能,以补充足够的营养和水分,增加机体抵抗力,对疾病的康复有重要意义。现将脑卒中后吞咽障碍的护理研究进展综述如下。     

脑卒中吞咽障碍的早期康复护理综述

脑卒中是多发于老年人的常见病,而吞咽障碍是常见并发症,严重影响患者的生活质量,甚至危及生命,从而影响疾病的治疗过程。本文通过近年来相关脑卒中患者吞咽障碍的早期康复护理的探讨,对脑卒中患者吞咽障碍的早期康复与护理进行综述。     

脑卒中患者吞咽障碍康复护理进展

吞咽障碍是脑卒中病人常见的并发症。文献报道，脑卒中患者有30％～73％发生吞咽难。因患者常因吞咽障碍发生误吸引起呛咳、肺部感染，严重者引起窒息甚至死亡，也可因进食困难而引起水、电解质及营养物质摄入不足，影响患者康复，因此，对意识清楚的吞咽障碍病人进行早期康复护理非常必要。现对吞咽障碍病人进行康复护理做一综述。     

110例脑卒中病人吞咽障碍早期康复护理

吞咽障碍是脑卒中病人常见的并发症。约 45 %脑卒中病人存在吞咽障碍。主要是吞咽、迷走和舌下神经的核性或核下性损害产生的真性球麻痹和 /或双侧皮质脑干束损害产生的假性球麻痹。由于病人在脑卒中早期存在不同程度的吞咽障碍 ,进食困难 ,可引起脱水及营养不良 ,也可引起吸入性肺炎 ,甚至窒息而危及生命。因此 ,对意识清楚的吞咽障碍病人进行早期康复护理非常必要。我科自 1997年 1月— 2 0 0 0年 3月对 110例吞咽障碍病人进行早期康复护理 ,收到了良好效果。1　临床资料1.1　一般资料 :本组 110例 ,男 6 6例 ,女 44例 ,年龄 5 0岁～ 86岁…     

脑卒中患者吞咽障碍的康复

脑卒中患者中有 71%的患者存在吞咽障碍。因此 ,对脑卒中患者除了积极开展言语治疗和肢体的运动等康复措施外 ,还应及早认识、及时进行吞咽功能障碍的康复治疗 ,以利于患者的全面康复。1吞咽障碍的类型和特点吞咽障碍包括吞咽前口腔准备时期 (口腔相 )的障碍和食物从口腔送入胃过程 (咽相 )中的障碍。根据病变部位 ,吞咽障碍主要有 3种类型 :①伴假性球麻痹引起的吞咽障碍 ;②伴球麻痹引起的吞咽障碍 ;③一侧大脑半球病变引起的吞咽障碍1.1假性球麻痹吞咽障碍的特点　与吞咽有关肌肉功能低下 ,协调性差 ;用口唇进食差 ,食物易从口唇掉落 ;咀…     

急性脑卒中患者吞咽障碍早期综合康复治疗与护理

吞咽障碍是脑卒中常见症状之一，急性期发生率约为51％,吞咽障碍可引起脱水、营养不良、机体抵抗力下降，影响患者康复及生活质量，患者易产生紧张、悲观、厌食甚至拒食心理，如果处理不当，还会出现生命危险。目前对吞咽困难的治疗方法很多，但缺乏大样本随机对照试验来验证哪种方法治疗吞咽困难最有效，所以对吞咽障碍的研究也是脑卒中康复治疗的重要课题之一。我科2004年1月-2005年12月对45例脑卒中并发吞咽障碍患者实施早期综合康复训练，取得较好疗效，现报道如下。     

老年脑卒中吞咽障碍患者早期康复护理存在的问题分析及对策

吞咽障碍是老年脑卒中患者常见的并发症。主要是吞咽、迷走神经和舌下神经的核性或核下性损害产生的真性球麻痹或双侧皮质脑干束损害产生的假性球麻痹。由于患者在脑卒中早期存在不同程度的吞咽障碍，进食困难，易引起脱水及营养不良，甚至可引起吸入性肺炎，严重者出现窒息甚至危及生命，而且死亡率较高。     

老年脑卒中后吞咽障碍的早期功能训练与摄食行为指导

为探讨老年脑卒中后吞咽障碍患者的早期康复介入护理方法，对30例老年脑卒中患者早期吞咽摄食障碍进行康复训练，在入院和治疗1个月后进行吞咽功能评定。结果30例患者，28例藤岛一郎吞咽疗效评价平均得分和才藤氏吞咽障碍分级均明显提高，有效率为93％。提示对老年脑卒中吞咽功能障碍患者早期康复介入，可以使患者恢复经口进食，提高生活质量。     

Pressure profile similarities between tongue resistance training tasks and liquid swallows

Tongue-pressure resistance training is known to increase tongue strength in seniors and individuals with stroke-related dysphagia. However, evidence of associated functional improvements in swallowing is equivocal. We investigated similarities in pressure waveform profiles between swallowing and several tongue-palate pressure tasks to identify tasks that may be best suited for inclusion in tongue-pressure resistance training protocols for patients who are unable to safely perform real bolus swallows in treatment. Tongue-palate pressures were recorded in 20 healthy young adults. Participants performed water and nectar-thick juice swallows, effortful and noneffortful saliva swallows, and "half-maximum" tongue-palate partial-pressure tasks emphasizing either anterior or posterior tongue-palate contact at different speeds. Pressure slopes (amplitude change over time) during the pressure application (rise) and withdrawal (release) phases were analyzed. A subset of four tasks with the greatest similarity in slope characteristics to those seen in bolus swallows was identified: anterior-emphasis half-maximum tongue-palate presses, posterior-emphasis maximum isometric tongue-palate presses, posterior-emphasis half-maximum slow tongue-palate presses, and effortful saliva swallows. We propose that future research should explore the degree to which swallowing improvements are obtained from treatment protocols that emphasize these tasks.     

Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults

OBJECTIVE: To assess the effects of effortful swallowing, a common compensatory strategy for dysphagia, on the bolus and swallowing mechanism of middle-aged and older men and women. DESIGN: Case-controlled design in which subjects completed both the intervention technique and the control behavior. SETTING: A university hospital. PARTICIPANTS: Sixty-four healthy men and women between 45 and 93 years of age from the community. INTERVENTIONS: Participants swallowed 3-mL thin liquid boluses both normally and using the effortful swallow strategy. MAIN OUTCOMES MEASURES: The biomechanics and bolus flow patterns of swallows were analyzed from videofluoroscopic and simultaneous oral pressure data. RESULTS: Subjects at all ages generated significantly increased oral pressures at each sensor location using the effortful swallow (p = .0001), with the pressure increase greater for the middle-aged subjects compared with older subjects. Several durational measures were significantly longer with the effortful swallow including: hyoid maximum anterior excursion (p < .04), laryngeal vestibule closure (p < .0001), and duration of the upper esophageal sphincter opening (p =.0001). The hyoid bone moved further in the superior direction with the effortful swallow (p = .002). There was a trend of decreased oral residue with the effortful swallow (p = .06). CONCLUSION: Biomechanical and bolus flow aspects of swallowing changed when healthy individuals performed effortful swallows with 3-mL boluses.     

Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows

Objective:

Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients?

Material and methods:

We examined 19 patients (12 men and 7 women, mean age 47 years, range 19–69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23–59 years).

Results:

Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by ±2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high LIES residual pressures, three with weak pharyngeal contractions, three with pharyngeal “spasms,” seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination.

Conclusions:

Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.     

Diagnosis of esophageal motor disorders: A prospective study comparing barium swallow,food barium mixture,and continuous swallows with manometry

Radiography and manometry of the esophagus were compared in 77 patients consecutively referred for manometric investigation on suspicion of esophageal motility disorder. Radiography and manometry were carried out simultaneously, and the results were assessed blindly. The examination comprised barium swallow, bread barium swallow, and barium swilling. Considering manometry as the standard, the overall sensitivity and specificity of the radiologic examinations were 90.4% and 92.0%, respectively. We conclude that radiology is an excellent investigation for the separation of patients with and without esophageal motility disorders, but correct subclassification often required manometry.     

疗养护理病历存在的缺陷分析及防预对策

目的调查疗养护理病历存在的缺陷,探求提高护理疗案质量的改进措施。方法对2002年10月至2004年10月的护理病历检查结果进行归纳分析。结果医嘱记录单存在的质量缺陷146次,一般护理记录单存在的质量缺陷142次,体温单存在的质量缺陷68次。结论注重护士的在职培训、实施有效的监督管理是护理疗案质量的保障。