吞咽功能的康复训练对卒中后肺炎的预防研究

Swallowing Function Rehabilitation Training Using for Preventing of Pneumonia after Stroke

目的观察吞咽功能康复训练对卒中后吞咽障碍的恢复与预防肺炎的效果及对预后的影响。方法对267例脑卒中住院患者进行床旁误吸试验,对误吸试验阳性的135例随机分为对照组与训练组,训练组进行各种吞咽功能训练,观察两组吞咽功能恢复、肺炎发生与死亡情况。结果在治疗后14 d与21 d,训练组床旁误吸试验阳性率分别为31.3%与20.6%,而对照组为47.8%和40.3%,训练组均较对照组低(P<0.05);发病后1个月内训练组肺炎发生率11.8%,对照组为22.4%,差异无统计学意义(χ2=2.69,P>0.05);但结合我们的以往资料进行比较,差异有统计学意义(χ2=4.25,P<0.05)。结论脑卒中后吞咽障碍是肺炎的重要危险因素,吞咽功能康复训练能促进患者恢复,减少肺炎发生,改善预后。

OBJECTIVE To observe the effect of swallowing function rehabilitation training on the recovery of dysphagia and the prevention of the pneumonia after stroke and the prognosis of stroke.METHODS Totally 267 stroke inpatients were investigated by bedside swallowing tests.From them 135 stroke inpatients with positive results of bedside swallowing tests were randomly divided into the training group and the control group.The training group was accepted swallowing function rehabilitation training.The recovery of dysphagia,the incidence of the pneumonia and mortality in the two groups were observed and compared with the previous data.RESULTS Most patients with dysphagia in the control group became better after acute stage.But higher rehabilitation rate and shorter recovering time were showed in the training group.The positive rate of bedside swallowing tests was 31.3% and 20.6% in training group vs 47.8% and 40.3% in control group,at 14 days and 21 days post-treatment.The positive rate of training group was lower than the control group（P〈0.05）.The incidence of the pneumonia was 11.8% in training group vs 22.4% in control group after one month.There was no statistical difference between the two groups（χ2=2.69,P〉0.05）.However,the statistical difference was found compared with our previous data.CONCLUSIONS Dysphagia after stroke is an important risk factor contributing to the occurrence of the pneumonia after stroke.Swallowing function rehabilitation training can facilitate the recovery of the patients,reduce the incidence of the pneumonia after stroke and improve the prognosis of stroke.But the further investigations are needed to do.