脑卒中患者吞咽障碍的康复护理体会

吞咽困难是卒中后常见并发症之一,有报道急性期吞咽障碍的发生率高达29%～71%[1],大多数是假性延髓麻痹引起,80%脑卒中急性期吞咽障碍1月内自愈,但仍有少数患者吞咽困难可导致持久性残疾或残障.     

艾灸联合系统护理干预脑卒中后吞咽困难疗效分析

目的 探讨艾灸联合系统护理干预脑卒中后吞咽困难的疗效分析.方法 60例脑卒中后吞咽困难患者随机分为实验组40例和对照组20例,实验组给予艾灸联合系统护理干预,对照组仅给予系统护理干预,比较2组疗效.结果 实验组32例患者吞咽困难缓解,6例有效,缓解率为80.0%,显著高于对照组的45.0%,差异有统计学意义（χ2=6.017,P=0.014）.实验组总有效率为95.0%,显著高于对照组的70.0%（χ2=5.210,P=0.022）.结论 艾灸联合系统护理干预可改善脑卒中后吞咽困难症状,为脑卒中后吞咽困难的治疗提供了新的思路.     

卒中单元个体化康复训练治疗脑卒中后吞咽困难76例临床分析

目的 探讨卒中单元内个体化康复训练对急性脑卒中后吞咽困难的治疗效果.方法 对我院卒中单元病房和普通病房内鉴别的148例脑卒中后吞咽困难患者,按所在病房分为康复治疗组76例和常规治疗组72例,康复治疗组进行针对性个体化康复训练,常规治疗组无吞咽困难康复训练计划和专业治疗小组,依患者意愿辅助进食.结果 康复治疗组疗效明显好于常规治疗组(P＜0.01),误吸性肺炎发生率显著低于常规治疗组(P＜0.01).结论 个体化康复训练明显改善急性脑卒中后吞咽困难患者的吞咽功能,显著降低误吸性肺炎的发生率,促进疾病的康复.     

家庭护理干预在脑卒中后吞咽困难患者中的应用效果

目的探讨家庭护理干预在脑卒中后吞咽困难患者中的应用效果。方法 196例脑卒中后吞咽困难患者按随机数字表法分成研究组和对照组各98例。对照组行常规护理,研究组在常规护理的同时给予家庭护理干预。对比2组护理前后吞咽功能评分、生活质量及负性情绪、并发症发生率。结果 2组护理前吞咽功能评分及生活质量得分均无明显差别(P0.05);研究组护理后吞咽功能、生活质量得分较对照组高(P0.05);焦虑及抑郁得分均低于对照组(P0.05),并发症发生率低于对照组(P0.01)。结论家庭护理干预可有效改善脑卒中后吞咽困难患者吞咽功能,并降低负性情绪和并发症,提高生活质量,是更为合理的护理方式。     

单侧脑半球卒中致吞咽障碍临床分析

吞咽障碍是急性脑卒中的重要并发症之一,伴发的误吸和吸入性肺炎常常使住院时间延长,增加患者的病死率[1,2].由于参与吞咽的后组颅神经受双侧大脑皮层神经元的支配,故一般认为单侧脑半球损伤不会显著影响吞咽功能.但在临床实践中,多数脑卒中患者急性发病仅累及单侧大脑半球并有吞咽困难发生,为此,加深对单侧半球卒中引起吞咽障碍的认识有着现实意义.     

Lancet Neurol：咽部电刺激有利于拔除气管套管

<正>卒中后吞咽困难是急性卒中的常见并发症,累及大约80%的患者,6个月后11%～50%的患者仍遗留吞咽困难。卒中后吞咽困难影响患者经口进食,这与脱水、营养不良、吸入性肺炎、延长住院时间、长期不良预后和死亡率增加有关。由于严重吞咽困难、长时间气道保护不足或需要长时间机械通气,1%～2%的卒中患者和25%入住重症监护病房(intensive care unit,     

英国卒中国家指南关于吞咽、喂食和营养的管理指南简介

英国皇家医师协会的卒中协作组在伦敦圣·托马斯医院Anthony Rudd医生和利物浦神经内科和神经外科Walton中心的Peter Humphrey医生组织下,于2004年6月正式完成了“卒中国家指南(第二版)的组稿工作。其中包括卒中后吞咽困难的诊断、治疗等科学管理的内容,也涉及到与吞咽困难密切相关的卒中患者营养的管理。对于每一条建议,均给出了证据级别(本文未列出)及建议级别A、B、C、D。     

脑卒中后吞咽困难的研究进展

正吞咽困难是脑卒中常见并发症之一,其发病率为51%~78%[1]。多数脑卒中患者吞咽功能障碍7 d内可恢复,然而,11%~13%的患者可能经历大于6个月的持续性吞咽困难。吞咽困难对脑卒中患者的预后及生存质量有深远影响,例如产生脱水、营养障碍、肺炎等[2-4]。目前虽有大量对脑卒中后吞咽困难的相关研究,但较少涉及脑卒中后患者吞咽困难的偏侧性、代谢及诊疗等方面。本文将对脑卒中后吞咽困难上     

经皮胃造瘘家庭肠内营养治疗卒中后营养不良14例分析

目的观察内镜下经皮胃造瘘（PEG）家庭肠内营养对卒中后吞咽困难营养不良的治疗作用。方法选择脑卒中后吞咽困难致营养不良患者14例,予PEG家庭肠内营养治疗,在治疗前、治疗后第15d、30d分别测量三头肌皮褶厚度、上臂肌围、血红蛋白、血淋巴细胞、血清白蛋白、血清钾,及行NHISS卒中量表和日常生活能力评分。结果PEG家庭肠内营养对卒中后吞咽困难营养不良治疗后各营养指标较治疗前提高,呈显著性差异（P〈0．05）;治疗后NHISS评分和日常生活能力评分有改善,有显著性差异（P〈0．05）。结论PEG下家庭肠内营养对卒中后吞咽困难营养不良有治疗作用。     

卒中后抑郁的发病机制及危险因素的研究进展

卒中后抑郁（post-stroke depression,PSD）是脑卒中后最常见的神经精神系统并发症。卒中后抑郁会导致包括残疾加重、发病率和死亡率增高等多种不良结果。了解卒中后抑郁的发病机制及危险因素，对卒中后抑郁的诊疗至关重要，期望能为卒中后抑郁的治疗提供新的可能。     

Persistent post-stroke dysphagia treated with cricopharyngeal myotomy

Post-stroke dysphagia is a common problem after stroke. About 8-13% patients have persistent dysphagia and are unable to return to pre-stroke diet even after 6 months of stroke. Use of percutaneous endoscopic gastrostomy (PEG) may be required in these patients, which may be psychologically unacceptable and impair the quality of life. In those with cricopharyngeal dysfunction leading on to refractory post-stroke dysphagia, cricopharyngeal myotomy and injection of botulinum toxin are the treatment options. We present a case of vertebrobasilar stroke who had persistent dysphagia due to cricopharyngeal dysfunction with good recovery of swallowing function following cricopharyngeal myotomy 1.5 years after the stroke.     

急性卒中后肺炎的早期风险识别和预防

急性卒中后肺炎是卒中患者最主要的严重并发症之一,是卒中患者不良预后和死亡的最重要原因。了解急性卒中后肺炎的危险因素和预测卒中后感染发生的免疫功能标记物有利于早期识别急性卒中后肺炎高危患者。卒中诱发的免疫抑制综合症（stroke-induced immunodepression system,SIDS）的相关研究为临床预防急性卒中后感染开创了新的方向。为了论证预防性抗菌治疗（preventiveantibacterial therapy,PAT）是否对急性卒中后感染有积极的预防作用,还需要进行更多的试验。采取综合性干预措施,如执行卒中临床医疗途径及卒中单元,可能是目前减少急性卒中后肺炎发生、促进卒中患者康复的合适选择。     

Impact of oral function on regaining oral intake and adjusting diet forms for acute stroke patients

BackgroundOutcome prediction for dysphagia recovery is essential for rehabilitation treatment planning. Several studies have reported various predictors for resuming oral feeding after post-stroke dysphagia. However, evidence on oral health and function, a crucial part of feeding, has rarely been reported. Therefore, the goal of this study was to identify the oral status-related factors that could predict oral intake resumption in acute stroke patients.Methods80 acute stroke patients with dysphagia were included. Clinical data, including the changes of general condition, oral and swallowing functions, were collected once a week until discharge. Patients were divided into two groups based on the outcome of the food intake level scale at discharge, and data were compared between the groups.Results60 patients had regained complete oral intake before discharge. Multiple logistic regression showed that posterior tongue pressure could significantly predict complete oral intake recovery. Tongue pressure and modified water swallowing test score also significantly influenced diet forms. In addition, Spearman correlation analysis showed that improvement of other oral status-related factors, such as oral moisture and dentition status, also indicated the improvement of diet forms and swallowing function during the hospital stay.ConclusionTongue pressure measurement could be a useful oral status-related indicator for predicting complete oral intake and adjusting diet forms for acute stroke patients during hospitalization. Acute stroke patients should receive proper oral status evaluation and implementation to enhance functional recovery.     

The Occurrence Rate of Swallowing Disorders After Stroke Patients in Asia: A PRISMA-Compliant Systematic Review and Meta-Analysis

BackgroundSwallowing disorders (dysphagia) is common in stroke patients. However, the epidemiology of post-stroke dysphagia (PSD) is poorly described. We herein synthesize the data of eligible studies on occurrence rate of dysphagia in Asian populations with stroke.MethodsWe searched the electronic databases (PubMed, Embase and Web of Science) to collect the studies on the prevalence of PSD. We used the Newcastle–Ottawa Scale (NOS) to estimate the quality of studies. The pooled dysphagia occurrence rate was obtained in Asian stroke patients.Results40 studies (including 43 observations) from 2318 initial references were selected in the synthetic analysis. The pooled occurrence rate of dysphagia in post-stroke patients was 36.3% (95% CI, 33.3%–39.3%). Meta-regression analysis showed that the “country” and “developing level” may influence the pooled occurrence rate of PSD.ConclusionDysphagia is common in Asian post-stroke patients. Our meta-analysis may raise concern about evaluating and managing dysphagia in stroke patients.     

脑卒中患者吞咽障碍及康复效果影像学研究

目的探讨电视X线透视吞咽功能检查（videofluoroscopic swallowing study,VFSS）在脑卒中患者吞咽功能评估中的应用价值,观察脑卒中后吞咽障碍发生情况,康复前后患者吞咽功能变化.方法脑卒中患者70例及健康成人80名分别作为研究组与对照组均进行VFSS,比较两组误吸等VFSS异常征象的发生情况.对发现误吸患者进行吞咽功能康复训练4周,训练后复查VFSS,比较训练前后吞咽异常的发生情况变化.结果对照组渗透或误吸、口腔滞留、咽腔滞留的发生率为5.0%,13.4%,25.3%.主要为轻度渗透及口咽腔滞留.研究组渗透或误吸、口腔滞留、咽腔滞留发生率为45.0%,46.5%,48.9%,主要为重度渗透或误吸,中重度口咽腔滞留.其中隐匿性误吸为10次（占总误吸的24.4%）.误吸患者康复治疗后渗透或误吸发生率较康复治疗前减少（P＜0.05）.结论脑卒中后吞咽障碍在康复期仍较为常见,可表现为多种影像学异常.VFSS可确切诊断吞咽异常,进行针对性康复训练,使患者吞咽功能提高.     

卒中后吞咽障碍的分子生物学研究进展

卒中后吞咽障碍是卒中后常见并发症,指患者由于卒中导致吞咽过程中的困难表现,其发生、发展的分子机制尚未阐明.调控吞咽功能的两个关键区域孤束核和疑核,其分泌的多种神经递质与吞咽功能密切相关.与孤束核密切相关的5-羟色胺(5-hydroxytryptamine,5-HT)及其受体5-HT1A、谷氨酸及N-甲基-D-天冬氨酸受...     

卒中患者血压水平与卒中后认知障碍关系的研究进展

卒中后认知障碍为卒中的常见并发症之一,可严重影响卒中患者的生活质量及预后。目前认为血压与卒中后认知障碍密切相关,血压可能对卒中后认知障碍的主要病理生理过程产生潜在影响,并且控制血压可能有助于卒中后认知障碍的改善或预防。血压与卒中后认知障碍之间的相关性较为复杂,可能取决于特定的血压参数和卒中的不同阶段。目前卒中后的最佳血压控制水平尚不统一。本文对卒中后认知障碍的流行病学,血压与卒中后认知障碍的相关性,血压影响卒中后认知障碍的相关机制,以及控制血压的作用进行综述,为进一步阐明卒中后认知障碍的病理生理过程提供重要依据,以期有助于指导临床治疗,从而改善卒中患者的预后。     

Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype.

Dysphagia in stroke is linked with increased risk of pneumonia, increased length of stay and poorer outcomes. This study followed a cohort of 88 acute ischaemic stroke patients admitted to hospitals in Perth, Western Australia, over 30 days. There were 8/88 deaths (9%). Infections were treated in 25/80 survivors (31%). Presence and severity of dysphagia were measured at 2 and 7 days post-stroke. Respiratory tract infections occurred at significantly higher rates for dysphagics (p<0.05). At 2 days post-stroke, the odds ratio (OR) of chest infection for dysphagics was 1.45 (95% CI=1.07-1.98). Survivors who were "nil by mouth" 2 days post-stroke were significantly more likely to develop pneumonia (p=0.01). At 7 days post-stroke, dysphagics were again more likely to develop pneumonia (p=0.014) with OR=1.77 (95% CI=1.26-2.49). The total anterior circulation infarcts demonstrated more severe and prolonged dysphagia than other stroke subtypes.     

Principles and requirements for stroke recovery science

The disappointing results in bench-to-bedside translation of neuroprotective strategies caused a certain shift in stroke research towards enhancing the endogenous recovery potential of the brain. One reason for this focus on recovery is the much wider time window for therapeutic interventions which is open for at least several months. Since recently two large clinical studies using d-amphetamine or fluoxetine, respectively, to enhance post-stroke neurological outcome failed again it is a good time for a critical reflection on principles and requirements for stroke recovery science. In principal, stroke recovery science deals with all events from the molecular up to the functional and behavioral level occurring after brain ischemia eventually ending up with any measurable improvement of various clinical parameters. A detailed knowledge of the spontaneously occurring post-ischemic regeneration processes is the indispensable prerequisite for any therapeutic approaches aiming to modify these responses to enhance post-stroke recovery. This review will briefly illuminate the molecular mechanisms of post-ischemic regeneration and the principle possibilities to foster post-stroke recovery. In this context, recent translational approaches are analyzed. Finally, the principal and specific requirements and pitfalls in stroke recovery research as well as potential explanations for translational failures will be discussed.     

The effect of fecal microbiota transplantation on stroke outcomes: A systematic review

Background and PurposeFecal microbiota transplantation (FMT) is a novel microbiota-based therapeutic method that transfers stool from donor into a recipient and its application is under investigating for neurological disorders such as stroke. In this systematic review, we assessed the effect of FMT in progression and treatment of stroke and recovery of post-stroke complications.MethodsPreliminary studies were searched in MEDLINE via PubMed, Scopus, COCHRANE library and Google Scholar, databases up to February 2022. The search strategy was restricted to articles about FMT in stroke. The initial search yielded 4570 articles, of which 19 publications were included in our systematic review.ResultsBased on outcomes transferring microbiome from healthy or ischemic donor to other ischemic recipient can affect brain infarct volume and survival rate, neurological and behavioral outcomes, and inflammatory pathways.ConclusionsOur systematic review on preclinical studies showed that manipulating gut microbiota via FMT can be a possible therapeutic approach for treatment of stroke and recovery of post-stroke complications.