吞水测试在急性脑卒中患者康复评估中的应用

目的调查急性缺血性脑卒中患者吞咽困难的发生情况,及早采取针对性措施,改善脑卒中患者吞咽功能,减少并发症发生。方法对100名急性缺血性脑卒中患者,在入院24 h内未进食、水之前由受过专门训练的康复护士进行吞水测试,有针对性地进行吞咽功能康复训练。结果23例未通过吞水测试,经过康复训练,调整饮食结构,其中19例(82.6%)出院前可以正常吞咽,有4例(17.4%)需留置经鼻胃管,鼻饲饮食。吞咽困难患者营养不良发生率较非吞咽困难者高,且早期预后差,住院天数延长。结论吞水测试能够及时测试缺血性脑卒中患者是否存在吞咽困难及其程度,及早采取针对性措施,可以减少吸入性肺炎等并发症,降低营养不良发生率,对脑卒中患者整体康复过程起着积极作用。     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

Electrical stimulation for swallowing disorders caused by stroke

BACKGROUND: An estimated 15 million adults in the United States are affected by dysphagia (difficulty swallowing). Severe dysphagia predisposes to medical complications such as aspiration pneumonia, bronchospasm, dehydration, malnutrition, and asphyxia. These can cause death or increased health care costs from increased severity of illness and prolonged length of stay. Existing modalities for treating dysphagia are generally ineffective, and at best it may take weeks to months to show improvement. One common conventional therapy, application of cold stimulus to the base of the anterior faucial arch, has been reported to be somewhat effective. We describe an alternative treatment consisting of transcutaneous electrical stimulation (ES) applied through electrodes placed on the neck. OBJECTIVE: Compare the effectiveness of ES treatment to thermal-tactile stimulation (TS) treatment in patients with dysphagia caused by stroke and assess the safety of the technique. METHODS: In this controlled study, stroke patients with swallowing disorder were alternately assigned to one of the two treatment groups (TS or ES). Entry criteria included a primary diagnosis of stroke and confirmation of swallowing disorder by modified barium swallow (MBS). TS consisted of touching the base of the anterior faucial arch with a metal probe chilled by immersion in ice. ES was administered with a modified hand-held battery-powered electrical stimulator connected to a pair of electrodes positioned on the neck. Daily treatments of TS or ES lasted 1 hour. Swallow function before and after the treatment regimen was scored from 0 (aspirates own saliva) to 6 (normal swallow) based on substances the patients could swallow during a modified barium swallow. Demographic data were compared with the test and Fisher exact test. Swallow scores were compared with the Mann-Whitney U test and Wilcoxon signed-rank test. RESULTS: The treatment groups were of similar age and gender (p > 0.27), co-morbid conditions (p = 0.0044), and initial swallow score (p = 0.74). Both treatment groups showed improvement in swallow score, but the final swallow scores were higher in the ES group (p > 0.0001). In addition, 98% of ES patients showed some improvement, whereas 27% of TS patients remained at initial swallow score and 11% got worse. These results are based on similar numbers of treatments (average of 5.5 for ES and 6.0 for TS, p = 0.36). CONCLUSIONS: ES appears to be a safe and effective treatment for dysphagia due to stroke and results in better swallow function than conventional TS treatment.     

Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses

Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating. Dysphagia affects between one and two thirds of patients with acute stroke, with the potential for life-threatening airway obstruction, aspiration pneumonia and malnutrition. Whilst associated with increased impairment, dysphagia may present in isolation or accompanied by minimal disability; universal screening of swallowing function is recommended. This study describes the process undertaken to review the evidence for dysphagia screening methods in patients with acute stroke. It also identifies, implements and establishes sensitivity and specificity of a screening tool (the Standardized Swallowing Assessment, SSA) for use by nurses. Not all ward staff had completed training to use the SSA by conclusion of the patient audit. Nonetheless 123 out of 165 assessable patients (74.5%) had their swallow function screened, 64 by SSA (52%). Based on 68 completed screening episodes by independently competent nurses, a comparison with summative clinical judgement of swallow function revealed a sensitivity of 0.97 and specificity of 0.9 for detection of dysphagia, with positive and negative predictive values of 0.92 and 0.96. This was significantly better than gag reflex performance, supporting the use of the SSA by competent ward nurses.     

家庭参与式口咽操训练在卒中后吞咽困难患者中的应用及效果评价

目的 探讨家庭参与式口咽操训练在卒中后吞咽困难患者的吞咽功能康复及营养状态改善中的应用及效果评价。方法 选取经洼田饮水试验评估为吞咽困难的脑卒中患者160例,按照随机数字法分为试验组与对照组,每组80例。对照组患者给予常规的吞咽功能训练,试验组给予常规的吞咽功能训练和家庭参与式口咽操训练。2组患者接受30d干预后,对其吞咽功能、吸入性肺炎发生率及营养状态进行评定与分析。结果 干预后,试验组吞咽困难改善情况好于对照组,差异具有统计学意义(P＜0.05);干预期间试验组吸入性肺炎发生率为11.25%,明显低于对照组(31.25%),差异具有统计学意义(P＜0.05);干预后,试验组营养风险评分为(2.74±0.69),明显低于对照组[(3.04±1.02)],差异具有统计学意义(P＜0.05)。结论 针对吞咽功能障碍的卒中患者,在常规吞咽功能训练的基础上加用家庭参与式口咽操可有效改善患者吞咽功能,降低吸入性肺炎的发生率,改善营养状态。     

肌内效贴对脑卒中吞咽障碍患者流涎的疗效

目的 观察肌内效贴对脑卒中后流涎的治疗效果。方法 2019年10月至2021年1月,脑卒中后吞咽障碍流涎患者40例随机分为对照组和试验组,各20例。两组均接受常规药物治疗、吞咽常规训练和吞咽困难康复护理,试验组加用肌内效贴,共3周。治疗前后采用功能性经口摄食评估量表(FOIS)、洼田饮水试验(WST)和教师流涎量表(TDS)进行评定。结果 试验组脱落1例。治疗后,两组FOIS、TDS和WST评分均改善(|Z| > 2.000, P < 0.05),试验组均明显优于对照组(|Z| > 3.045, P < 0.01)。结论 配合肌内效贴可进一步改善脑卒中后吞咽障碍患者的流涎。     

两种管饲法对脑卒中吞咽障碍的效果

目的探讨两种管饲方法对脑卒中后吞咽功能的影响。方法将60 例急性缺血性脑卒中患者分为对照组和观察组各30 例。在康复训练的基础上,对照组给予留置鼻胃管法进行营养支持,观察组同时给予间歇性口胃管营养法进行营养支持。收集两组患者入院24 h 内及30 d 的洼田饮水试验及吞咽障碍的程度评分(VGF)。结果入院30 d,观察组洼田饮水试验、VGF评分优于对照组(P<0.05)。结论采取间歇性口胃管营养法可以对脑卒中吞咽功能改善起到积极的作用。     

Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST©): Are 10 teaspoons of water necessary?

Abstract

Dysphagia screening often includes administration of water. This study assessed the accuracy in identifying dysphagia with each additional teaspoon of water. The original research of the TOR-BSST^© permitted this assessment. Trained nurses from acute and rehabilitation facilities prospectively administered the TOR-BSST^© to 311 eligible stroke inpatients. A sensitivity analysis was conducted for the water item using 10 teaspoons plus a sip as the standard. The proportion of positive screenings was 59.2% in acute and 38.5% in rehabilitation. Of all four items that form the TOR-BSST^©, the water swallow item contributed to the identification of dysphagia in 42.7% in acute and 29.0% in rehabilitation patients. Across all patients, dysphagia accuracy was that five teaspoons resulted in a sensitivity of 79% (95% confidence interval [CI] = 70–86), eight a sensitivity of 92% (95% CI = 85–96) and 10 a sensitivity of 96% (95% CI = 90–99). Although a primary contributor, the water swallow item alone does not identify all patients with dysphagia. For a water swallow to accurately identify dysphagia, it is critical to administer 10 teaspoons. The TOR-BSST^© water swallow item contributes largely to the total TOR-BSST^©'s screening score and in making the test highly accurate and reliable.     

Poststroke hand swelling and oedema: prevalence and relationship with impairment and disability

OBJECTIVE: To examine the prevalence of swelling and oedema of the hand in stroke patients and relationships with impairments and disability. DESIGN: Cross-sectional. SETTING: Stroke unit at Rehabilitation Centre De Hoogstraat, The Netherlands. SUBJECTS: Eighty-eight adult stroke patients who were admitted for clinical rehabilitation during one year (2000). MEASUREMENTS AND METHODS: Assessment took place two weeks after admission to the rehabilitation centre. Degree of swelling was measured with a hand volumeter and oedema was defined as a volumeter score deviating more than two standard deviations from the expected score derived from population data. Further assessment included tonus (Modified Ashworth Score), sensibility, tactile inattention, carefulness, and motor function (Utrecht Arm/Hand Test). Arm disability was measured with Frenchay Arm Test and Nine-hole Peg Test. RESULTS: Some degree of hand swelling was present in 72.7% and oedema in 33.0% of our patients. Swelling and oedema were significantly more often seen in patients with hypertonic fingers and impaired sensibility. Patients with hand oedema had significantly worse Frenchay Arm Test and Nine-hole Peg Test scores. CONCLUSIONS: Swelling and oedema of the hand are common among stroke patients in clinical rehabilitation.     

早期肠内营养支持对脑卒中后重症吞咽障碍患者预后的影响

目的 探讨早期肠内营养支持对急性脑卒中后重症吞咽障碍患者预后的影响.方法 将符合才藤氏吞咽障碍7级评价法1级标准的139例急性脑卒中后吞咽障碍患者随机分成早期肠内营养组(EEN,n=69)和早期肠外营养组(EPN,n=70),在给予综合治疗的基础上,采用不同方法的营养支持,观察两组治疗前及治疗4w后血清白蛋白,非瘫痪侧上臂三头角肌肌围(MAMC)、三头肌皮褶厚度(TSF)等体重相关营养指标的变化及腹胀、应激性溃疡、肺部感染、病死率等临床并发症发生情况.结果 治疗4w后后,EEN组在营养学指标:血清白蛋白、TSF、MAMC、体重优于EPN组,差异有统计学意义(P<0.05),EEN组并发症发生数小于EPN组,其中并发应激性溃疡、肺部感染者差异有统计学意义(P<0.05),其余差异无统计学意义.结论 重症吞咽障碍是影响脑卒中神经功能康复的因素之一,也是加剧营养状况恶化、并发症发生的主要诱因,脑卒中合并重症吞咽困难患者早期应用肠内营养支持,可改善机体的营养状况,减少并发症发生,有利于患者的康复.     

Swallow Screen Associated With Airway Protection and Dysphagia After Acute Stroke

ObjectiveThe goal was to examine the outcomes of an existing swallow screen protocol in comparison to results from a formal videofluoroscopic protocol.DesignProspective cohort study.SettingAcute hospital.ParticipantsPatients after acute stroke (N=48).InterventionsNot applicable.Main Outcome MeasuresThe Johns Hopkins Hospital Brain Rescue Unit 3 oz Swallow Screen was implemented by nursing staff upon admission. Videofluoroscopy was conducted within 72 hours of diagnostic neuroimaging and initial swallow screen. Predictive values of the bedside swallow screen (pass/fail) for clinical judgment of dysphagia on videofluoroscopy (presence/absence) were calculated. Overall impairment scores from the Modified Barium Swallowing Impairment Profile were analyzed with respect to swallow screen results.ResultsThirteen participants failed the swallow screen, and 35 passed. Of the 35 patients who passed the swallow screen, 15 were clinically diagnosed with dysphagia on videofluoroscopy. Although pass/fail of the swallow screen was not a significant predictor of presence/absence of dysphagia, a logistic regression model including components of Laryngeal Elevation, Laryngeal Vestibule Closure, and Anterior Hyoid Excursion, and sex was statistically significant for swallow screen outcome.ConclusionThe results of this study suggest that a swallow screen of aspiration risk can identify patients with the most need for videofluoroscopic evaluation and dysphagia management. Additionally, patients who fail a swallow screen are more likely to present with physiologic impairments related to airway protection on videofluoroscopy.     

基于VFSS/MBS的吞咽困难饮食调整策略

饮食调整是一种吞咽困难康复常用而又重要的干预手段。根据电视X线透视吞咽功能研究／改良吞钡造影，可以明确患者能够适应的固体／液体食物种类、适宜的每口摄入量和吞咽时有效的姿势调整方法，以确定安全、有效的吞咽困难饮食调整策略，尽量保证经口进食，促进患者吞咽功能的康复。