脑卒中吞咽障碍患者发生误吸的影响因素及预防措施

目的探讨脑卒中吞咽障碍患者发生误吸的影响因素及预防措施。方法选择2018年1月～12月我院诊断治疗的脑卒中吞咽困难患者90例为研究对象,根据是否发生误吸分为误吸组与无误吸组。采用单因素与多因素分析脑卒中吞咽障碍患者发生误吸的影响因素,并探讨预防措施。结果单因素分析结果显示,年龄≥70岁,咳嗽反射减弱,有机械通气,双侧病变,脑干及小脑病变的患者发生误吸的比例要更高(P0.05);而半卧位、半流质饮食的患者发生误吸的比例更低(P0.05)。多因素分析结果显示,年龄≥70岁、咳嗽反射减弱、机械通气、双侧病变、脑干及小脑病变是脑卒中吞咽障碍患者发生误吸的独立危险因素。而半卧位、半流质饮食是保护因素(P0.05)。结论高龄、咳嗽反射减弱、机械通气、双侧病变、脑干及小脑病变患者容易发生误吸,而半卧位、半流质饮食能减少误吸风险。临床工作中,对于有高危因素的患者更应注意预防误吸,可通过口腔护理、吞咽功能训练、半卧位、半流质饮食等措施预防误吸发生。     

高龄脑卒中吞咽障碍患者误吸的影响因素分析

目的分析高龄脑卒中吞咽障碍患者误吸的影响因素,为制定防护策略,降低该类患者误吸提供依据。方法选取医院2019年4月—2020年4月住院的高龄脑卒中吞咽障碍患者111例,对患者的性别、年龄、既往病史、鼻胃管进食、口腔运送时间、镇静药物或抗精神病药物、神志、是否合并多种高龄慢性疾病、进食卧位、是否有人工气道等数据进行统计学分析,筛选高龄脑卒中吞咽障碍患者误吸的影响因素。结果单因素分析显示,年龄≥75岁、气管切开与机械通气、仰卧位、进食过快、口腔运送时间大于1.5 s、咽启动延迟、会厌谷残留是影响高龄脑卒中吞咽障碍患者误吸的影响因素(P<0.05)。多因素Logistic回归分析显示,年龄≥75岁、气管切开与机械通气、仰卧位、口腔运送时间大于1.5 s是高龄脑卒中吞咽障碍患者的影响因素(P<0.05)。结论高龄吞咽障碍的误吸发生率较高,护理人员需加强对上述高危因素的识别与防护,及时消除高危因素,降低误吸发生风险。     

脑卒中吞咽障碍患者进食体位依从性对误吸发生率的影响

目的:探讨脑卒中后吞咽障碍患者进食体位依从性对误吸发生率的影响。方法:将40例脑卒中后吞咽障碍患者随机分为对照组和观察组各20例,对照组采用脑卒中常规护理,进食体位随意;观察组除执行常规护理外,进食时采用床头摇高角度固定三脚架、患者头架护理,保持进食时抬高床头30°~45°。比较两组进食体位的依从性及误吸发生率。结果:观察组比对照组进食体位依从性高,误吸发生率明显降低(P0.05)。结论:对脑卒中吞咽障碍患者,及时进行护理干预,提高患者对进食体位的依从性,有利于减少误吸的发生。     

脑卒中后吞咽困难病人进食期间发生误吸影响因素分析及护理对策

目的:分析脑卒中后吞咽困难病人进食期间发生误吸的影响因素,并提出针对性的护理预防对策。方法:回顾性分析2018年1月—2021年12月医院收治的193例脑卒中后吞咽困难病人的临床资料,根据病人住院期间是否发生误吸分为误吸组和无误吸组,采用单因素分析与Logistic回归分析影响病人进食期间发生误吸的因素,并根据独立影响因素提出护理干预措施,以预防误吸的发生。结果:193例脑卒中后吞咽困难病人进食期间发生误吸71例(36.78%);单因素分析显示,年龄、咳嗽反射、卒中病史、卒中部位、机械通气、进食体位、环咽肌开放异常、喉上抬幅度不足、吞咽功能评价量表(SSA)评分影响脑卒中后吞咽困难病人误吸的发生(P<0.05);多因素分析显示,年龄、咳嗽反射减弱、小脑或脑干病变、机械通气、环咽肌开放异常、喉上抬幅度不足、SSA评分>24分均是影响脑卒中吞咽困难病人进食误吸发生的独立危险因素,而半卧位进食是保护因素(P<0.05)。结论:脑卒中后吞咽困难病人进食期间容易发生误吸,年龄、咳嗽反射减弱、小脑或脑干病变、机械通气、环咽肌开放异常、喉上抬幅度不足、SSA评分>24分均是脑...     

食物形态改变结合吞咽护理在脑卒中吞咽障碍患者中的应用效果

目的探讨食物形态改变结合吞咽护理在脑卒中吞咽障碍患者中的应用效果。方法选取2017年1月—2018年11月本院神经内科收治的58例脑卒中吞咽障碍患者作为研究对象,根据入院先后顺序分为两组,对照组(n=30)和观察组(n=28),其中对照组患者给予常规留置鼻胃管并实施常规鼻饲护理,观察组患者在对照组基础上对食物形态进行改变后尝试经口进食。对比两组拔除鼻胃管时的洼田饮水试验级别、留置鼻胃管天数、误吸和吸入性肺炎发生情况以及护理满意度。结果两组患者拔除鼻胃管时的洼田饮水试验各级别人数对比差异有统计学意义(P 0. 01);观察组留置鼻胃管天数显著少于对照组(P 0. 01);观察组误吸和吸入性肺炎情况与对照组对比无统计学意义(P 0. 05);观察组患者对护理工作的总满意度(97. 32%)显著高于对照组(82. 50%),差异有统计学意义(P 0. 01)。结论食物形态改变结合吞咽护理能减少脑卒中吞咽障碍患者鼻胃管的留置时间,提高操作安全性及护理满意度。     

脑卒中吞咽障碍患者应用体位固定器的效果观察

目的探讨自制体位固定器用于吞咽障碍患者进食体位固定的护理效果。方法选取本院神经内科脑卒中后吞咽障碍患者40例作为研究对象,随机分为对照组和观察组各20例。对照组采用随意进食体位护理,观察组采用体位固定器保持床头抬高30°~45°固定进食体位护理,比较两组进食体位执行情况及误吸发生率。结果观察组患者发生误吸的现象与对照组比较明显减少,差异有统计学意义(P0.05)。结论脑卒中吞咽障碍患者使用固定器固定进食体位,保持床头抬高30°~45°进食,可减少误吸发生,利于提高患者的生活质量,缩短住院天数,降低社会、家庭经济负担。     

急性球麻痹患者早期经鼻胃管进食预防肺炎的效果分析

目的探讨急性脑卒中球麻痹患者早期经鼻胃管进食预防肺炎的效果以及对近期预后的影响.方法球麻痹吞咽困难评估在3级和4级的急性脑卒中患者196例,按吞咽困难级别随机分成鼻胃管组和非鼻胃管组,鼻胃管组在常规治疗基础上早期经鼻胃管进食,非鼻胃管组在常规治疗基础上经口进食.观察两组误吸及肺炎的发生率,并对患者入院时及病程第3～4周的神经功能缺损进行评分.结果两组入院时神经功能缺损评分比较无统计学意义,病程第3～4周鼻胃管组神经功能缺损评分明显低于非鼻胃管组,有统计学意义(P＜0.01);鼻胃管组肺炎发生率明显低于非鼻胃管组.结论急性脑卒中球麻痹患者早期经鼻胃管进食,能明显降低肺炎发生率,有利于神经功能的恢复.     

脑卒中后吞咽障碍患者发生相关性肺炎的危险因素分析

目的：探讨康复期的老年缺血性脑卒中后吞咽障碍患者发生脑卒中相关性肺炎（SAP）的危险因素.方法：脑卒中后吞咽障碍患者148例,回顾性分析患者年龄、性别、糖尿病和房颤病史、鼻胃管进食、构音障碍、肺炎、改良Barthel指数、脑卒中分类、外周血淋巴细胞计数,用多因素Logistic回归探讨发生SAP的相关影响因素.结果：148例中发生SAP感染56例（37.8％）,未发生SAP感染92例;通过多因素Logistic 回归调整年龄和性别等因素后发现,误吸、年龄≥75岁、男性、糖尿病、房颤是康复期老年脑卒中后吞咽障碍患者SAP的独立危险因素（P＜0.01,0.05）,外周血淋巴细胞计数高是其保护因素（P＜0.05）.此外鼻胃管进食、构音障碍也是该类患者SAP发生的影响因素（P＜0.01,0.05）.结论;老年脑卒中后吞咽障碍患者发生SAP的风险值得关注,通过对这一系列危险因素的筛查和监控,可提高医院和家庭对康复期老年脑卒中后吞咽障碍患者的重视程度,改善其预后.     

健侧完全侧卧位进食干预对减少脑卒中吞咽障碍患者误吸的效果评价

目的 探讨健侧完全侧卧位进食干预对减少脑卒中吞咽障碍患者误吸的应用效果。方法 选取2021年1月-12月我院收治的脑卒中吞咽障碍患者80例为研究对象,采用随机数字表法分为观察组和对照组,各40例。观察组采取健侧完全侧卧位进食护理,对照组采取自觉舒适的体位进食护理。比较两组误吸发生率及出院率。结果 观察组刺激性呛咳、发音异常和气促的误吸症状发生率明显低于对照组(P<0.05),观察组出院率高于对照组(P<0.05)。结论 健侧完全侧卧位进食干预简便、安全,可减少脑卒中吞咽障碍患者误吸的发生,提高出院率,可应用于临床。     

急性脑卒中合并吞咽困难患者早期经鼻饲管肠内营养的相关研究

目的:研究急性脑卒中合并吞咽困难患者早期经鼻饲管肠内营养的临床效果。方法:将180例脑卒中合并吞咽困难患者按入院顺序分为实验组和对照组各90例,实验组常规治疗基础上早期留置鼻胃管进食,对照组常规治疗基础上经口进食。比较两组患者治疗3周后的营养指标、神经功能恢复、误吸及肺炎发生情况。结果:实验组的各项营养指标、神经功能恢复评分优于对照组(P0.01),误吸及肺炎的发生明显少于对照组(P0.05)。结论:对急性脑卒中合并吞咽困难患者应早期经鼻饲管肠内营养支持治疗。     

出院准备计划在脑卒中后留置鼻饲管患者中的应用研究

目的:探讨出院准备计划对脑卒中后留置鼻饲管患者的影响.方法:将脑卒中后留置鼻饲管的患者65例,按入院时间的先后顺序分为对照组32例和观察组33例.对照组行常规的脑卒中后留置鼻饲管患者的护理,观察组实施出院准备计划.比较两组患者留置鼻饲管的时间、吸入性肺炎的发生率、吞咽相关生存质量(SWAI-QOL)得分.结果:出院后1...     

The effect of nasogastric tubes on swallowing function in persons with dysphagia following stroke

OBJECTIVE: To determine whether the use of a nasogastric tube influences swallowing function in stroke patients with dysphagia. DESIGN: Before-after trial. SETTING: Primary care center. PARTICIPANTS: A total of 22 patients with stroke (12 men, 10 women; mean age, 69.7 y; range, 19-85 y) participated in the study. Time from onset of stroke to time of assessment averaged 20.3 days (range, 14-38 d). All participants continued to use a nasogastric tube for nutrition supply and had either minor or no aspiration of barium on videofluoroscopic examination of swallowing (VFES). INTERVENTION: The swallowing function was evaluated by VFES with thin and thick bariums (5 mL each) as a contrast medium. MAIN OUTCOME MEASURES: The oral transit, swallowing trigger, and pharyngeal transit times were measured and compared before and after the removal of the nasogastric tube. The patients were also observed for changes in velopharyngeal closure, pharyngeal contraction, epiglottic tilt, valleculae stasis, pyriform sinus stasis, penetration, and aspiration. RESULTS: Transit times were reduced by 0.2 to 0.6 seconds after removal of the nasogastric tube, but the reduction was not statistically significant. These transit times were slightly longer with thick barium than with thin barium, but were without statistical significance. Similarly, most of the patients had no change in nontemporal assessment of swallowing function after the tube was removed. CONCLUSIONS: The placement of a nasogastric tube did not affect temporal and nontemporal measurement of swallowing in stroke patients with dysphagia with or without minor aspiration.     

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome:Two case reports

BACKGROUND A swallowing disorder may occur following a brainstem stroke,especially one that occurs in the swallowing centers.Lateral medullary syndrome(referred to as LMS),a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery,has been reported to lead to more severe and longer lasting dysphagia.CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique(known as HEST).The two patients had no other functional incapacity back into life,but nasogastric feeding was the only possible way for nutrition because of severe aspirations.Swallowing function was evaluated by functional oral intake scale,modified water swallow test,surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration,pharyngeal residue,pharyngeal peristalsis,upper esophageal opening and the ability of deglutition.Both patients were treated with the HEST method for dysphagia and recovered quickly.CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.     

Tube feeding in patients with advanced dementia: knowledge and practice of speech-language pathologists

Context

Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia.

Objectives

To assess factors associated with SLPs’ knowledge and recommendations about feeding tubes in patients with advanced dementia.

Methods

A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate = 53.7%). Self-perceived preparedness, knowledge, and care recommendations were measured. Knowledge items were scored as “evidence based” or not according to the best evidence in the literature.

Results

Only 42.1% of SLP respondents felt moderately/well prepared to manage dysphagia. Only 22.0% of respondents recognized that tube feeding is unlikely to reduce risk of aspiration pneumonia whereas a slight majority understood that tube feeding would not likely prevent an uncomfortable death (50.2%), improve functional status (54.5%), or enhance quality of life (QOL) (63.2%). A majority (70.0%) was willing to consider recommending oral feeding despite high risk of aspiration. Logistic regression analyses indicated that those willing to consider this recommendation gave the most evidence-based responses to knowledge questions about tube feeding outcomes: aspiration pneumonia (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.07–2.87), functional status (OR = 1.43, 95% CI = 1.0–2.06), QOL (OR = 2.19, 95% CI = 1.52–3.17), and prevent uncomfortable death (OR = 1.97, 95% CI = 1.37–2.88). Logistic regression analyses also indicated that those with more experience evaluating patients with dementia gave the most evidence-based response to two knowledge questions: aspiration pneumonia (OR = 2.64, 95% CI = 1.48–4.72) and prevent uncomfortable death (OR = 2.03, 95% CI = 1.35–3.05) whereas those with higher self-perceived preparedness in managing dysphagia in dementia had less knowledge in two areas: aspiration pneumonia (OR = 0.57, 95% CI = 0.38–0.84) and QOL (OR = 0.72, 95% CI = 0.51–1.01).

Conclusion

Misperceptions among SLPs about tube feeding in advanced dementia are common, especially in relation to risk of aspiration. Knowledge about tube feeding outcomes was positively associated with experience and inversely associated with self-perceived higher preparedness in evaluating patients with dementia.     

ICU机械通气患者呼吸机相关性肺炎危险因素与护理对策

目的探讨ICU机械通气患者呼吸机相关性肺炎(VAP)发生的危险因素及护理对策,为临床降低VAP发生率提供理论支持。方法选取2018年1月至2019年6月在我院ICU机械通气患者175例为研究对象,并发VAP 60例。采用多因素logistic回归分析法分析VAP发生危险因素。结果多因素logistic回归分析结果显示,年龄(OR=1.624)、APACHEⅡ评分(OR=1.915)、侵袭性操作(OR=1.942)、口腔清洁状况(OR=2.178)、机械通气时间(OR=2.652)、意识障碍(OR=2.154)为影响ICU机械通气VAP发生的独立危险因素(P<0.05)。结论ICU机械通气患者VAP发生的危险因素多且复杂,应采取针对性干预措施,尽量缩短机械通气、住院时间,加强防护,降低VAP发生风险,促进患者康复。     

Status Of Dysphagia After Ischemic Stroke: A Korean Nationwide Study

ObjectiveTo identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia.DesignRetrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort.SettingAcute care university hospitals.ParticipantsPatients (N=6000) with first-ever acute ischemic stroke. Patients were divided into 2 groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests.InterventionsNot applicable.Main Outcome MeasuresAge at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), poststroke mRS, and ASHA-NOMS swallowing level at poststroke day 7 were evaluated.ResultsAmong patients with ischemic stroke, 32.3% (n=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (n=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI <18.5 kg/m²), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds ratio (OR) for the presence of dysphagia significantly increased with underweight (OR, 1.6684; 95% confidence interval [CI], 1.27-2.20), increased age at onset (OR, 1.0318; 95% CI, 1.03-1.04), premorbid mRS (OR, 1.1832; 95% CI, 1.13-1.24), brainstem lesions (OR, 1.6494; 95% CI, 1.39-1.96), and NIHSS (OR, 1.2073; 95% CI, 1.19-1.23).ConclusionsThe incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.     

脑卒中后病灶部位与吞咽功能的关系

目的明确脑卒中不同病灶部位与吞咽功能的关系。方法选取2005 年6 月~2007 年4 月间连续入住卒中单元的符合纳入标准的缺血性脑卒中患者。记录入院后患者头MRI所显示的陈旧及新卒中病灶的部位并进行分类。电视透视检查(VF)明确有无吞咽异常及误吸。分析病灶部位与吞咽障碍及误吸之间的关系。结果满足条件者共211 例,同时获得VF评估资料以及头MRI资料的患者共有169 例。159 例存在吞咽功能损伤,误吸94 例。口期异常72 例(9 例缺失),咽期异常150 例。不同卒中病灶间出现吞咽障碍及误吸发生率无显著性差异(P>0.05)。延髓损伤有易于误吸的趋势(P=0.056)。幕上(P=0.028)和延髓以上(P=0.005)损伤容易造成口期异常。结论大脑皮质、皮质下白质、脑干及小脑的损伤,包括单侧半球损伤均可导致吞咽障碍和误吸。延髓损伤可能容易导致误吸,幕上或延髓水平以上的损伤容易造成口期异常。     

体位干预对脑卒中吞咽障碍患者误吸的影响

目的：探讨体位干预对脑卒中吞咽障碍患者误吸的影响。方法将60例急性脑卒中并吞咽障碍患者分为对照组与干预组,每组各30例。对照组进食时摇高床头30～40°,干预组进食时摇高床头30～40°,用头架（头架用颈托改装而成）固定头部,并使头稍向健侧倾斜。比较两组患者误吸发生率。结果干预组患者误吸发生率比对照组明显减少,两组比较差异具有统计学意义（ P＜0．05）。结论进食时摇高床头30～40°,同时采用三角架固定头部,并使头稍向健侧倾斜可有效地减少脑卒中吞咽障碍患者误吸的发生。