急性脑卒中患者吞咽困难与营养不良的相关性调查及对策

Investigation of correlation of dysphagia and malnutrition of patients with acute stroke and the countermeasures

目的调查急性脑卒中患者吞咽困难的发生情况与营养不良发生的相关性，并制订相应的护理干预措施。方法对100例急性脑卒中患者，在入院24h内未进食之前由康复护士进行床旁吞水测试，判断患者是否存在吞咽困难，并有针对性地进行吞咽功能的康复训练，同时对患者的营养情况进行测评，随后追踪观察2周再测评1次，并判断患者营养不良发生情况。结果100例急性脑卒中患者中，23．0％（231100）在入院时存在吞咽困难，护理干预后有19例占82．5％出院前可以正常吞咽。13．0％需留置胃管。有吞咽困难的患者中营养不良的发生率占34．8％明显高于无吞咽困难患者占11．7％，差异有统计学意义（P〈0．05），且其第4周时的日常生活能力较无吞咽困难者低，病残程度高，平均住院日延长。结论及时评估急性脑卒中患者吞咽困难的情况，尽早给予重视并制订科学的营养供给和康复训练计划，可以降低脑卒中患者营养不良的发生率，减少其并发症的发生，降低其病残程度，促进早日康复。

Objective To investigate the correlation of dysphagia and malnutrition of patients with acute stroke and to establish intervention Methods The Swallow Water Test was performed by professional rehabilitation nurses in 100 cases of acute stroke patients without food and water within 24 hours after admission and two weeks later to confirm the existence of dysphagia. Rehabilitation exercises of swallow function were performed pertinently. At the same time, we evaluate the state of nutrition of these patients and followed up for two weeks, and to determine the state of malnutrition. Results There was 23.0%（23/100） acute stroke patients didn＇t pass the initial Swallow Water Test, 19 patients （82.5%） with dysphagia could swallow normally before discharge, 13% patients needed indwelling nasal-gastric tube. The rate of malnutrition in dysphagia group （34.8%） was higher than patients without dysphagia （11.7%）, the difference was statistically significant （P 〈 0.05）. In addition,the activity ability of daily living was poorer,the disability degree was higher and the average day of hospitalization was longer in dysphagia group in the fourth week. Conclusions To estimate the dysphagia timely in acute stroke patients can make the medical staff think highly of this status to formulate the scientific project of nutrition and provide the scientific rehabilitation exercises to the patients. It can decrease the incidence rate of malnutrition, complications and the disability degree of the acute stroke patients and to promote early rehabilitation.