床旁血氧饱和度测定评估脑卒中患者的吞咽功能

Evaluation of deglutition function with the measurement of oxygen saturation beside bed in patients with stroke

目的:误吸可致反射性的支气管收缩,使血氧饱和度下降,故利用床旁血氧饱和度测定可反映脑卒中患者的吞咽功能。方法:选取2003-02/2005-02华北煤炭医学院附属开滦医院收治的首次发病的急性脑卒中后吞咽障碍患者120例,根据患者意愿分为康复组与非康复组各60例。对康复组患者入院后24h进行康复训练(包括冷刺激训练、舌运动训练、软腭上抬训练、喉活动训练、进食训练及面肌训练),上下午各1次,每次30min,至患者出院为止。非康复组患者使用传统的鼻饲管护理等对症处理。两组患者入院及出院时进行饮水实验(口腔含水至咽完的时间<5s为Ⅰ级,6～10s为Ⅱ级,11～15s为Ⅲ级,>16s为Ⅳ级,Ⅴ级为不能咽下,达Ⅰ,Ⅱ级者可正常进食)评估患者的吞咽功能。选取同期住院无肺部疾患的椎基底动脉供血不足患者50例作为对照组。对照组和康复组入院及出院时持续测定患者吞咽前后的血氧饱和度(饮水实验时),计算吞咽前后血氧饱和度降低值评估吞咽功能。结果:按意向处理分析,两组120例患者和对照组50例均进入结果分析。①饮水实验前后血氧饱和度降低值:康复组入院时显著高于出院时和对照组[(2.72±1.07)%,(1.90±0.91)%,(1.24±0.58)%,t=7.26,4.25,P<0.001]。②饮水实验分级:入院时康复组与非康复组无差异,出院时康复组Ⅰ级18例,Ⅱ级16例,Ⅲ级10例,Ⅳ级9例,Ⅴ级7例;非康复组Ⅰ级7例,Ⅱ级10例,Ⅲ级13例,Ⅳ级14例,Ⅴ级16例,两组比较差异显著(χ2=11.22,P=0.024)。结论:血氧饱和度测定可在床旁反映和评价脑卒中患者的吞咽功能,方法简便易行。

AIM： The mistaken suck can induce the reflectivity bronehoconstriction, make blood oxygen saturation decrease, so the deglutition function in patients with stroke can be reflected with the measurement of blood and oxygen saturation beside bed. METHODS： 120 patients with stroke who were the first time onset of the disease and treated in Kailuan Affiliated Hospital of North China Coal Medical College were selected from February 2003 to February 2005. According to the will of the patients they were assigned into rehabilitation group and non-rehabilitation group with 60 in each group. The rehabilitation training was performed 24 hours after the hospitalization of the patients in rehabilitation group （including cold stimulation training, tongue movement training, soft palate lifting training, throat activity training, eating training and facial muscles training）, once at forenoon and afternoon respectively and 30 minutes every time, till the discharge of the patients.The patients in non-rehabilitation group were treated with traditional nasal feeding tub nursing care etc. to dispose on the symptom. The patients in the two groups at hospitalization and discharge were conducted drinking experiment （the time of holding water till swallowing in mouth less than 5 s for Ⅰ grade, 6-10 s for Ⅱ grade, 11-15 s for Ⅲ grade, more than 16 s for Ⅳ grade, unable to swallow for Ⅴ grade, the patients who were Ⅰ grade and Ⅱ grade can eat normally） to assess the deglutition function of patients. Fifty patients who hospitalized in the same period without pulmonary disease but with vertebrobasilar arterial insufficiency were selected as control group. When hospitalization and discharge the patients in control group and rehabilitation were tested continuously on the blood and oxygen saturation before and after swallow （at drinking experiment）, and the reduction value of the blood and oxygen saturation before and after swallow was calculated to evaluate the deglutition function. RESULTS： According to intention-to-treat analysis, 120 patients in the two groups and 50 patients in control group were all involved in the result analysis, ① The reduction value of the blood and oxygen saturation before and after drinking experiment： It was significantly higher at hospitalization in rehabilitation group than that at discharge and that in control group [（2.72±1.07）%, （ 1.90±0.91 ）%, （ 1.24±0.58 ）%, t=7.26,4,25, P 〈 0.001]. ② The classification of drinking experiment： There were no difference in rehabilitation group and non-rehabilitation group at hospitalization, At discharge in rehabilitation group Ⅰgrade with 18 cases, Ⅱ grade with 16 cases, Ⅲ grade with 10 cases, Ⅳ grade with 9 cases, Ⅴ grade with 7 cases; in non-rehabilitation group Ⅰ grade with 7 cases, Ⅱ grade with 10 cases, Ⅲ grade with 13 cases, Ⅳ grade with 14 grade, Ⅴ grade with 16 cases, the comparison between the two groups showed significant difference （X^2=11,22, P=-0.024）. CONCLUSION： The measurement of blood and oxygen saturation can refl.ect and evaluate the deglutition function in patients with stroke beside bed, and the method is simple and easy to carry out.