间歇性鼻饲在老年脑卒中后吞咽障碍患者中的应用效果观察

目的 探讨间歇性鼻饲在老年脑卒中后吞咽障碍患者中的应用效果。方法 选取2021年09月-2022年09月收治的老年脑卒中后吞咽障碍患者94例,按随机数字表法分为两组,每组47例。对照组采取持续经鼻胃管置管鼻饲法,观察组采用间歇性鼻饲法,两组患者均持续干预两周。比较两组吞咽功能、营养状态、口咽舒适度、并发症和生活质量。结果 观察组干预后标准吞咽功能量表(SSA)中临床检查、饮水测试以及正常进食评分均低于对照组(P<0.05)。观察组干预后前白蛋白(PA)、血红蛋白(Hb)、血清白蛋白(ALB)、转铁蛋白(TRF)水平均高于对照组(P<0.05)。观察组干预后舒适状况量表(GCQ)中社会文化、生理、心理及环境评分高于对照组(P<0.05)。观察组误吸、肺部感染、腹泻、呕吐等并发症少于对照组(P<0.05)。观察组干预后吞咽障碍特异性生存量表(SWAL-QOL)中心理负担、进食持续时间、进食欲望、症状发生频率、食物的选择、交流、恐惧、心理健康、社交、劳累以及睡眠评分均高于对照组(P<0.05)。结论 间歇性鼻饲可改善老年脑卒中后吞咽障碍患者吞咽功能,提高患者营养...     

老年吞咽障碍患者死亡相关因素分析及预见性护理干预

目的 探讨老年吞咽障碍患者死亡主要相关因素及预见性护理干预措施.方法 采用回顾性调查法对106例老年吞咽障碍患者中死亡患者具体死因进行临床分析.结果 106例老年吞咽障碍患者,6例发生窒息,其中5例死亡;11例发生吸入性肺炎,其中4例死亡.结论 老年吞咽障碍患者容易发生窒息及吸入性肺炎等并发症,而这些并发症病死率高.护理的关键是从饮食护理、提高吞咽功能等方面进行干预,预防并发症的发生.     

针刺配合功能训练治疗脑卒中后吞咽障碍疗效分析

目的观察针刺配合功能训练治疗脑卒中后吞咽障碍的疗效。方法将脑卒中后伴吞咽障碍的100例患者随机分为对照组和治疗组。对照组采用功能训练治疗;治疗组采用针刺配合功能训练治疗。2周为1疗程,连续治疗2个疗程。2组在治疗前及治疗第14d、28d行吞咽X线电视透视检查（VFFS）和洼田氏评定。结果两组均能改善吞咽障碍,但针刺配合功能训练的疗效优于单纯功能训练（P〈0．05）。结论针刺配合功能训练不仅可以加速患者脑卒中后吞咽障碍的功能康复,提高生活质量,而且副作用小,花费少,可以作为脑卒中后吞咽障碍的常规治疗手段。     

电视荧光放射录相术对中风后吞咽障碍检查的临床价值

目的 探讨电视荧光放射录相术（VFG）对中风后蚕咽障碍检查的价值。材料与方法 中风后吞咽障碍组60例和健康中老年人组20例行VFG，分别记录两组受试者吞咽稀钡及半胶钡（含钡面糊）过程中的口通过时间和咽通过时间，并评价口、咽功能，记录有无舌肌运动减弱，钡剂残留梨状隐窝、会厌Xi，是否误吸入气管。结果 （1）吞咽障碍组各吞因时相通过时间均较健康中老年组延长。（2）会厌Xi钡剂残留在患者中发生率最高（45．0％；33．3％），梨状隐窝钡剂残留发生率较高（35．0％；25．0％）。脑干病变组各病理征象发生率均高于大脑半球病变组。经统计学处理，脑干病变组与大脑半球病变组误吸发生率有显著性差异（P＜0．05）。结论 VFG可以对吞咽全过程特别是咽时相的病理征象进行更详细的观察，是中风后吞咽障碍检查的有效方法。     

老年脑卒中患者吞咽障碍施行综合护理的可行性分析

目的：探讨老年脑卒中患者吞咽障碍施行综合护理的可行性。方法选择接受治疗的脑卒中后吞咽障碍的患者108例,将所有患者随机分为观察组与对照组,每组54例,给予对照组患者常规护理,观察组在对照组的基础上给予心理护理、吞咽障碍护理训练等综合护理干预,评估两组患者实施护理干预后吞咽障碍情况,评价护理有效率,并依据GQOL－74量表对两组患者的生活质量进行评分。结果观察组护理有效率为92.6％（50／54）,明显高于对照组的66.7％（38／54）,组间差异显著,具有统计学意义（P＜0.05）,观察组患者的生活质量评分为（81.35±8.26）分,对照组患者的生活质量评分为（67.58±9.01）分,组间差异显著,具有统计学意义（ P＜0.05）。结论对老年脑卒中吞咽功能障碍患者实施综合护理,能有效改善患者的吞咽功能,提高患者的生活质量,具有可行性,值得临床推广。     

吞咽造影在脑损伤患者吞咽障碍的临床价值

目的探讨吞咽造影(videofluoroscopic swallowing study, VFSS)对脑损伤患者吞咽障碍疗效评估。方法 40例脑卒中及脑外伤吞咽障碍患者,分别采用稀钡、浓稠钡和糊状钡三种不同性状、相同容量的钡剂,对吞咽障碍患者治疗前、后进行吞咽造影检查,根据吞咽造影对吞咽障碍患者治疗前、后进行吞咽功能评估比较分析。结果 40例患者均能清晰观察到整个吞咽过程,观察吞咽启动、喉上抬、会厌谷残留、梨状窝残留、渗透及误吸等情况,其中吞咽启动时间、喉上抬比治疗前明显改善(P0.05)。结论吞咽造影检查能有效评估脑损伤合并吞咽障碍患者的吞咽功能,其有助于指导临床选择有效治疗措施及提供观察治疗效果的依据。     

糊状饮食对脑卒中患者营养状态和吞咽功能的影响

 目的 观察脑卒中糊状饮食患者营养状态和吞咽功能。方法 选取我院神经血管外科2014-09至2015-11月收治的脑卒中并中轻度吞咽障碍患者77例,随机分为观察组38例和对照组39例。观察组进行糊状饮食喂养。对照组根据患者情况采取鼻饲或普通饮食。观察比较两组患者营养状况指标和吞咽障碍程度。结果 干预21 d后观察组血红蛋白浓度(125.33±12.09)g/L,明显高于对照组(117.28±14.32)g/L,差异有统计学意义(P<0.05),血清蛋白浓度(39.11±1.98)g/L,明显高于对照组(37.22±2.61)g/L,差异有统计学意义(P<0.05)。观察组吞咽障碍评分改善的患者例数明显多于对照组。结论 糊状饮食利于脑卒中患者营养状况的改善,促进吞咽功能的改善。     

康复训练对脑卒中后吞咽困难预后影响的研究

目的探讨脑梗死后吞咽困难患者采用康复训练后对吞咽功能预后的影响。方法选择284例脑梗死患者,随机分为康复组和对照组,康复组采用特定的康复治疗,对照组采用一般常规治疗。结果两组患者第28天吞咽障碍分级比较显示,康复组患者吞咽功能的恢复优于常规组。结论对脑梗死吞咽困难患者予以康复治疗后,可促进吞咽功能的重建与恢复,从而提高生活质量。     

针刺与吞咽训练治疗缺血性脑卒中后吞咽障碍疗效分析

目的观察针刺与吞咽训练结合治疗缺血性脑卒中后吞咽障碍的临床疗效。方法我院收治的缺血性脑卒中后吞咽障碍患者120例,分为吞咽训练组、针刺＋吞咽训练组两组进行治疗,每组60例。参照洼田饮水试验于治疗前及治疗3周后进行评定,比较两组临床疗效。结果经过3周治疗,针刺＋吞咽训练组治疗总有效率为91.67%,明显优于吞咽训练组（58.33%）（P〈0.05）。结论针刺与吞咽康复训练结合更能有效改善吞咽功能。     

脑卒中合并吞咽困难的早期评估及治疗

 目的 观察脑卒中合并吞咽困难的发病率、早期标准吞咽功能评估方法 及治疗效果.方法 对132例急性脑卒中患者进行早期标准吞咽功能评估,选择其中56例合并吞咽困难患者随机分成治疗组和对照组.治疗组根据评估情况选择综合治疗措施,对照组按照常规治疗,治疗时间为4周,以治疗前后吞咽功能恢复情况及吸入性肺炎发生率作为观察指标.结果 急性脑卒中后吞咽困难发生率为52%,治疗组吞咽功能恢复率显著高于对照组,治疗组吸入性肺炎发生率明显低于对照组.结论 吞咽困难是脑卒中急性期最常见的问题,对这类患者进行早期标准吞咽功能评估,并及时干预能有效促进吞咽功能恢复,降低吸入性肺炎的发生率.     

急性脑卒中患者合并吞咽困难的临床分析与康复治疗

目的观察急性脑卒中合并吞咽困难患者康复治疗的疗效评定及吸入性肺炎的发生率。方法将168例急性脑卒中合并吞咽困难的患者随机分为康复组和对照组,康复组在对照组应用药物治疗的同时给予综合康复训练治疗。治疗时间为1个月．以治疗前后患者吞咽功能恢复情况及吸入性肺炎的发生率作为观察指标。结果康复组患者吞咽功能恢复情况显著优于对照组,而其吸入性肺炎的发生率显著低于对照组。结论对于急性脑卒中合并吞咽困难的患者早期给予及时、系统的综合康复训练能够有效改善患者的吞咽功能,并显著减少此类患者吸入性肺炎的发生率。     

Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia

OBJECTIVE: The purpose of our investigation was to determine the relationship between the degree of swallowing dysfunction observed on barium studies and the likelihood of developing pneumonia in a large series of patients. MATERIALS AND METHODS: The findings on videofluoroscopic swallowing studies in 381 patients were used to classify these patients into one of five groups: those with normal swallowing; those with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration; those with laryngeal penetration; those with tracheobronchial aspiration; and those with silent tracheobronchial aspiration. Clinical data were also reviewed to determine how many patients had developed pneumonia during the 6 months before or after the barium studies. The data were then analyzed to determine whether the risk of developing pneumonia increased significantly with each level of swallowing dysfunction seen on barium studies. RESULTS: No significant difference was found in the frequency of pneumonia in patients with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration compared with patients with normal swallowing on barium studies (p = 0.85). In contrast, patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration were approximately four times (p = 0.008), 10 times (p < 0.0001), and 13 times (p < 0.0001), respectively, more likely to develop pneumonia than those with normal swallowing. CONCLUSION: Our findings indicate that the likelihood of developing pneumonia is directly related to the degree of swallowing dysfunction seen on videofluoroscopic studies. Patients with no laryngeal penetration-regardless of whether they had normal or abnormal swallowing-have the lowest risk of developing pneumonia. Patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration are, in increasing order of magnitude, significantly more likely to develop pneumonia than patients with normal swallowing.     

Defective closure of the laryngeal vestibule: frequency of pulmonary complications

Aspiration and its potential complications, bronchopneumonia and other pulmonary diseases, were studied in 67 fully conscious and mobile patients with cineradiographically verified dysfunction of swallowing. They were compared to a group of 67 patients of similar age with normal swallowing. Bronchopneumonia was found in nine (13%) of the patients with aspiration compared to two (3%) of the patients without (p = 0.05). Chronic pulmonary disease was more frequently observed in patients with aspiration than in those without, seven (10%) and one (1.5%), respectively (p = 0.03). Even though pulmonary complications of defective closure of the laryngeal vestibule are not frequent, swallowing training for fully conscious and relatively mobile patients would seem desirable.     

脑卒中后吞咽功能障碍患者两种治疗效果比较

 目的 观察呼吸训练联合低频电刺激对脑卒中后吞咽功能障碍患者的吞咽功能及呼吸功能的影响。方法 选取2018-04至2019-08我院收治的102例脑卒中后吞咽功能障碍患者为研究目标,按随机数字表法分为对照组和观察组,每组51例,对照组采用常规治疗即吞咽功能训练,观察组在对照组基础上加用呼吸训练与低频电刺激。采用洼田饮水试验评价两组临床疗效,以呼气峰流速(PEF)、一秒用力呼气量(FEV)、用力肺活量(FVc)、吞咽功能为观察指标,判断并比较两组患者的治疗效果。结果 治疗前观察组患者和对照组患者的肺功能测定PEF、FEV1、FVC三项指标均差异无统计学意义,治疗1个月后观察组患者PEF=5.46±1.01(L/s),FEV₁=2.92±0.59(L/s),FVC=3.76±0.83(L),较治疗前三项指标明显增高(P＜0.05),而对照组患者治疗后PEF=4.27±0.94(L/s),FEV₁=2.38±0.66(L/s),FVC=2.67±0.61(L),较治疗前相比基本没有变化,观察组肺功能改善情况明显优于对照组(P＜0.05);治疗前观察组患者和对照组患者的吞咽造影检查(VFSS)评分差异无统计学意义,治疗1个月后,两组患者的VFSS评分较治疗前相比均明显提高(P＜0.05),且观察组(VFSS=9.01±0.67)显著高于对照组(VFSS=7.98±0.87)(P＜0.05);治疗后观察组患者的治疗显效率84.31%,对照组患者的显效率为60.78%,观察组的治疗效果明显高于对照组(P＜0.05)。结论 在吞咽功能训练的基础上加以呼吸训练联合低频电刺激能够明显改善脑卒中后吞咽功能障碍患者的吞咽功能和呼吸功能,促进神经功能重塑,治疗效果较好。     

基于冲脉理论针刺治疗联合康复训练在脑卒中患者吞咽功能障碍中的临床研究

目的 探讨基于冲脉理论针刺治疗联合康复训练在脑卒中患者吞咽功能障碍中的应用价值。方法 选取2017年5月-2019年5月期间因脑卒中后吞咽功能障碍在解放军联勤保障部队桂林康复疗养中心进行救治的80例患者作为研究对象,按就诊顺序单双号分为观察组（n=40,基于冲脉理论针刺联合康复训练）和对照组（n=40,常规针刺联合康复训练）。比较两组患者疗效、治疗前后吞咽功能量表（SSA）评分和电视透视吞咽功能（VFSS）评分。结果 治疗后,观察组SSA评分（22.10±7.21）和VFSS评分（8.93±1.88）均显著优于对照组（26.08±8.11）分和（5.46±2.12）分,（均P<0.05）,观察组治疗总有效率97.50%显著高于对照组82.50%（P<0.05）。结论 基于冲脉理论针刺治疗联合康复训练对脑卒中患者吞咽功能障碍有积极的影响,可改善吞咽功能,提高治疗效果,值得推广应用。     

Complications after laryngeal surgery: videofluoroscopic evaluation of 120 patients

AIM: Videofluoroscopic assessment of the spectrum and incidence of swallowing complications after state-of-the-art laryngeal cancer surgery. MATERIALS AND METHODS: We retrospectively studied videofluoroscopic examinations of 120 patients (94 men, 26 women; mean age, 58 years) with suspected complications after laryngeal resection (partial laryngectomy, 65; total laryngectomy, 55). Swallowing function (i.e., oral bolus control, laryngeal elevation and closure, presence of pharyngeal residue, aspiration) and structural abnormalities such as strictures, fistulas and tumour recurrence were assessed by videofluoroscopy. RESULTS: Abnormalities were found in 110 patients, including strictures in nine, fistulas in six and mass lesions in 13 patients. Aspiration was found in 63 patients overall (partial laryngectomy, 61/65; total laryngectomy, 2/55), occurring before swallowing in five, during swallowing in 34, after swallowing in nine and at more than one phase in 15 patients. Pharyngeal paresis was detected in three and pharyngeal weakness in 19 patients. Pharyngo-oesophageal sphincter dysfunction was observed in 10 cases. CONCLUSION: Aspiration is a very common complication after partial laryngeal resection. It is mainly caused by incomplete laryngeal closure, sphincter dysfunction or pharyngeal pooling. Videofluoroscopy is the only radiological technique able to identify both disordered swallowing function and structural changes after laryngeal resection. Detection of these complications is crucial for appropriate further therapy.Kreuzer, S. H. (2000). Clinical Radiology55, 775-781.     

Videofluoroscopy of swallowing in symptomatic patients who have undergone long-term intubation

OBJECTIVE: The aim of this study was to evaluate whether specific patterns of swallowing dysfunction occur in symptomatic patients after long-term intubation. SUBJECTS AND METHODS: Twenty-one patients (16 men, five women; mean age, 66 years) who presented with clinical signs of aspiration after long-term intubation (mean duration, 24.6 days) underwent videofluoroscopy. They were analyzed for functional abnormalities of the tongue, soft palate, epiglottis, hyoid and larynx, pharynx, and the upper esophageal sphincter. We assessed the presence or absence of aspiration, the type of aspiration (pre-, intra-, and postdeglutitive), and a spectrum of other swallowing abnormalities. RESULTS: There were 18 patients (86%) with radiologically proven aspiration. In another patient only laryngeal penetration occurred. There were 11 combinations of pre-, intra-, and postdeglutitive aspiration. Predeglutitive aspiration was predominant and present in 52% of our patients. We found functional abnormalities of the tongue in 48%, of the soft palate in 10%, of the epiglottis in 48%, of the pharynx in 71%, and of the upper esophageal sphincter in 24%. CONCLUSION: Patients who are symptomatic after undergoing long-term intubation do not develop a specific type or pattern of swallowing dysfunction or aspiration, but show a large variety of aspiration types and associated swallowing disorders. Nevertheless, videofluoroscopy has the ability to reveal complex deglutition disorders and to aid precise planning of individualized functional swallowing therapy.     

Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography

Introduction

Bedside swallowing assessments are often used to assess dysphagia. However, in some patients, aspiration pneumonia occurs without any problems on bedside swallowing assessments and some patients do not suffer aspiration pneumonia despite abnormal results of bedside swallowing assessments in acute stroke. To detect the differences of lesions related to bedside swallowing assessment abnormality and aspiration, we investigated swallowing-related functional lesions in terms of cerebral blood flow in patients with dysphagia after stroke.

Methods

The study included 50 acute stroke patients who underwent bedside swallowing assessments and videofluorography as well as single-photon emission computed tomography (CT) at approximately the same time. Bedside swallowing assessments included repetitive saliva swallowing test and modified water swallowing test as dry and wet swallowing tasks. The presence or absence of aspiration was assessed using videofluorography. We divided patients into three subgroups based on the outcomes of the bedside swallowing assessments and presence or absence of aspiration. Statistical image analysis was performed using single-photon emission CT to determine their relationship with bedside swallowing assessments and videofluorography results.

Results

Twenty-seven (54.0 %) and 28 (56.0 %) patients had abnormal repetitive saliva swallowing test and modified water swallowing test results. Videofluorography indicated aspiration in 35 (70.0 %) patients. In comparing patients with and without abnormal results on each test, the groups with abnormal repetitive saliva swallowing test, abnormal modified water swallowing test, and aspiration demonstrated lower cerebral blood flow in the left precuneus, left insula, and anterior cingulate gyrus, respectively.

Conclusions

Based on the analysis of cerebral blood flow, functional lesions differed across abnormal repetitive saliva swallowing test and abnormal modified water swallowing test findings and aspiration on videofluorography, and each test may assess different functions among the many processes involved in swallowing.     

Do dysphagic patients with an absent pharyngeal swallow have a shorter survival than dysphagic patients with pharyngeal swallow? Prognostic importance of a therapeutic videoradiographic swallowing study (TVSS)

PURPOSE: To study survival in two groups of dysphagic patients--one group unable to elicit the pharyngeal stage of swallow (APS) and another group with pharyngeal swallow (WPS)--and to compare recommendations regarding nutrition and therapeutic strategies based on the therapeutic swallowing study. MATERIAL AND METHODS: In this retrospective study, the records of dysphagic patients who have undergone a therapeutic videoradiographic swallowing study (TVSS) were reviewed. Forty patients without pharyngeal swallow were matched for age and gender with 40 patients with pharyngeal swallow; altogether 80 patients were included in the study. Survival was registered at 3, 12, and 72 months after the TVSS. RESULTS: In this study, the APS group had a significantly shorter survival time (P=0.0030) compared to the WPS group when followed-up at 12 months. In the APS group, most patients (37.5% (15/40)) died within the 3 months after TVSS. At 72 months, 62.5% (25/ 40) of the patients in the APS group had died. In the WPS group, 5% (2/40) had died within 3 months and 47.4% (19/40) after 12 months. At 72 months, 52.5% (21/40) of the patients in the WPS group had died. Regarding nutritional and therapeutic recommendations based on TVSS, 34/40 in the APS group were recommended no oral intake. Eighteen naso-gastric tubes were placed directly after TVSS. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, and tongue exercises (in 8 patients). In the WPS group, all patients were recommended oral intake. Diet modification was recommended in 29 patients. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, tongue exercises, supraglottic swallow, and effortful swallow (in 24 patients). CONCLUSION: Patients unable to elicit the pharyngeal stage of swallow had a shorter survival time than patients with pharyngeal swallow, probably due to a more severe underlying disease. Tube feeding was more frequent in the APS group. Fewer therapeutic strategies were recommended compared to the WPS group. In the WPS group, diet modification was frequent. Several patients had different therapeutic strategies. At the end of the study, 8/40 patients (20%) in the APS group had recovered and regained the ability to elicit the pharyngeal stage of swallow. All eight had achieved active swallowing rehabilitation.