ACI患者吞咽困难的评估和临床相关因素分析

Dysphagia sequential evaluation in patients with acute cerebral infarction and related clinical factors analysis

目的优化急性脑梗死(ACI)患者吞咽困难的评估方法,并探讨其相关的临床因素。方法选择65例河北医科大学第二医院神经内科2017年10月至2018年10月收治的ACI伴吞咽困难患者为研究对象,建立了一种包括进食评估问卷调查工具-10(EAT-10)、反复唾液吞咽测试、洼田饮水试验和容积-黏度吞咽测试(V-VST)的序贯多元的吞咽困难的评估方法,进一步依据洼田饮水试验结果对吞咽困难程度进行分级,根据V-VST结果将患者分为使用糖浆组和使用布丁或管饲组,分析两组的临床资料。结果ACI合并吞咽困难的患者对这种序贯多元的评估方法耐受良好,依从性高,且该方法不仅对吞咽困难的评估更全面、精准,还能指导饮食,从而降低了吸入性肺炎的发生率。放射冠急性梗死使用糖浆黏度的患者显著多于使用布丁黏度或管饲患者(P<0.05)。进食黏度的不同与ACI患者吞咽困难的程度有关。轻中度吞咽困难的患者使用糖浆黏度的多,重度吞咽困难的患者使用布丁黏度甚至管饲的明显增多(P<0.05)。多因素Logistic回归分析结果显示使用不同黏度饮食与吞咽困难的不同分级、是否有放射冠区和脑干的ACI独立相关(P<0.05)。结论ACI患者吞咽困难的程度与ACI部位相关。放射冠区梗死的患者吞咽困难程度轻,多推荐使用糖浆黏度的食团;脑干梗死的患者吞咽困难程度重,推荐使用布丁黏度的食团或管饲。序贯多元的评估方法能够更精准地帮助诊断并指导患者饮食,为ACI患者吞咽困难的康复提供帮助。

Objective To optimize the method of dysphagia evaluation in patients with acute cerebral infarction(ACI)and to investigate its clinical influencing factors.Method 65 patients with dysphasia were enrolled in this study who were diagnosed as ACI in the neurology department of Second Hospital of Hebei Medical University from October 2017 to October 2018.A sequential multiple method including eating assessment questionnaire tool-10(EAT-10 test),repeated saliva swallowing test,water swallowing test and volume-viscosity swallow test(V-VST)was applied to evaluate dysphasia.According to the results of water swallowing test,the degree of dysphagia was graded.Based on the results of V-VST,the patients were divided into syrup group,pudding or tube feeding group.The clinical data of the two groups were analyzed.Results Patients with ACI combined with dysphagia were well tolerated and highly compliant with this sequential multicomponent assessment method.This method was more comprehensive and accurate to evaluate dysphasia and guide patients’diet,which reduced the incidence of aspiration pneumonia.Syrup viscosity was significantly higher in the patients with radiative crown infarction than the pudding or tube feeding(P<0.05).The difference of feeding viscosity was related to the degree of dysphagia in patients with ACI.The use of syrup viscosity was more in patients with mild or moderate dysphagia,and the use of pudding viscosity or even tube feeding was significantly increasing in patients with severe dysphagia(P<0.05).Multiple factors Logistic regression analysis suggested that different viscosity was related independently with the grade of dysphagia,corona radiata infarcts and of the brainstem infarcts(P<0.05).Conclusions The degree of dysphagia is correlated with the location of ACI.The degree of dysphagia is mild in patients with corona radiata infarction,syrup boluse is recommended for those kind of patients.Dysphagia is much severe for patients with brainstem infarction,and pudding boluse or tube feeding is recommended.Sequential multiple assessment can help more accurately to diagnose and evaluate dysphagia patients with ACI and guide patients’diet,which is benefical for rehabilitation of dysphagia patients with ACI.