间歇性鼻饲配合吞咽训练在脑卒中吞咽障碍患者中的应用

Application study of intermittent nasal feeding combined with swallowing training in patients with dysphagia and stroke

目的探讨间歇性鼻饲联合吞咽训练在脑卒中吞咽障碍患者中应用的可行性及效果。方法选择2016年1月至2019年1月菏泽市中医医院收治的脑卒中吞咽障碍患者120例,采用信封密封法随机分为对照组和观察组,每组60例。对照组采用长期留置胃管鼻饲+常规吞咽训练干预,观察组采用间歇性鼻饲+吞咽训练,比较两组吞咽功能障碍分级、营养状况变化及并发症发生情况。结果干预8周后,两组吞咽功能障碍分级优于干预前,观察组吞咽功能障碍分级优于对照组(P<0.05)。干预8周后,两组血清白蛋白(Alb)水平低于干预前,前白蛋白(PA)水平高于干预前,观察组血清Alb水平低于对照组,PA水平高于对照组(P<0.05)。两组吞咽造影检查(VFSS)评分逐渐提高,干预4周后、干预8周后观察组VFSS评分高于对照组(P<0.05)。观察组并发症发生率低于对照组(P<0.05)。结论间歇性鼻饲配合吞咽训练能够有效提高脑卒中吞咽障碍患者的吞咽功能,降低并发症发生率,改善营养状况,值得推广应用。

Objective To explore the feasibility and effects of intermittent nasal feeding combined with swallowing training in patients with dysphagia and stroke.Methods Totally 120 patients with stroke and dysphagia in Heze Hospital of Traditional Chinese Medicine were selected from January 2016 to January 2019.Envelope sealing method was used to randomly divide them into control group and observation group,with 60 cases in each group.The control group was treated with long-term indwelling gastric tube nasal feeding and conventional swallowing training intervention,while the observation group was treated with intermittent nasal feeding and swallowing training.The dysphagia dysfunction classification,nutritional status and complications of the two groups were compared.Results After 8 weeks of intervention,the dysphagia dysfunction classification of both groups was more superior than before.And the classification of the observation group was better than that of the control group(P<0.05).The serum Alb levels in two groups decreased after 8 weeks of intervention,while PA levels of the two groups increased.Compared with the control group,the observation group had lower Alb level and higher PA level(P<0.05).The VFSS score of the two groups of patients gradually increased,and the scores of observation group were higher than those of the control group at 4 weeks and 8 weeks of intervention,respectively(P<0.05).The incidence of complications in observation group was lower than that in the control group(P<0.05).Conclusion The application of intermittent nasal feeding combined with swallowing training in patients with dysphagia and stroke can effectively improve their swallowing function,reduce the incidence of complications and improve the nutritional status,which is worth promoting.