间歇经口至食管管饲在急性卒中合并吞咽障碍患者中的应用研究

目的 探讨间歇经口至食管管饲(intermittent oro-esophageal tube feeding,IOE)在急性卒中合并吞咽障碍患者中的应用效果.方法 本研究为前瞻性随机对照研究,连续纳入2018年1月-2020年9月南京大学医学院附属鼓楼医院急诊科收治的急性卒中合并吞咽障碍患者,使用分层随机化方式将患者...

The Application of Intermittent Oro-Esophageal Tube Feeding in Acute Stroke Patients with Dysphagia

Objective To evaluate the application effacy of intermittent oro-esophageal tube feeding(IOE)in acute stroke patients with dysphagia.Methods This prospective randomized controlled trial enrolled acute stroke patients complicated with dysphagia who were admitted to Department of Emergency of Nanjing Drum Tower Hospital from January 2018 to September 2020.All the patients were randomly divided into nasogastric feeding group and IOE group.Water swallow test and standardized swallowing assessment(SSA)were used to evaluate the swallowing function of all the patients at admission and discharge.The BMI,hemoglobin(Hb),albumin(ALB)and prealbumin(PA)of all the patients were collected.Meanwhile,the length of stay,aspiration pneumonia,peptic ulcer,constipation,diarrhea,vomiting and mucosa injury of mouth and nose were compared between the two groups.Results 126 acute stroke patients were included for analysis finally,with 62 cases in nasogastric feeding group and 64 in IOE group.Although the number of patients with dysphagia grade 1 and 2 in IOE group was higher than that in nasogastric feeding group at discharge,there was no statistical difference.The improvement of SSA score in IOE group was better than that in nasogastric feeding group(24.88±3.07 vs 28.87±3.04,P<0.001).For nutritional state,the level of ALB(37.40±4.40 g/L vs 35.31±3.32 g/L,P=0.003),PA(0.28±0.04 g/L vs 0.24±0.03 g/L,P<0.001)and Hb(127.60±6.93 vs 124.76±6.69 g/L,P=0.021)were all higher in IOE group than in nasogastric feeding group at discharge;the incidence of aspiration pneumonia(4.69%vs 22.58%,P=0.007),vomiting(3.13%vs 25.81%,P=0.001)and mucosa injury of mouth and nose(0 vs 17.74%,P=0.001)and the length of stay(median:15 days vs 17 days,P=0.029)in IOE group were all lower than that in nasogastric feeding group.Conclusions IOE could provide appropriate nutrition support and improve swallowing function in acute stroke patients with dysphagia,and reduce the incidence of the complications of aspiration pneumonia,vomiting and mucosa injury of mouth and nose.