后循环脑梗死急性期吞咽障碍的管理对吸入性肺炎的影响

Effect of the management of dysphagia with the acute posterior circulation infarction on aspiration pneumonia

目的探讨后循环脑梗死急性期吞咽障碍的管理对吞咽障碍致吸入性肺炎的影响。方法随机将93例后循环脑梗死急性期发生吞咽障碍的患者分成康复组30例,管理组31例,对照组32例,治疗4周后记录3组吞咽功能障碍功能的恢复情况,给予治疗后吸入性肺炎症状改善的情况以及吸入性肺炎发生率。结果康复组总有效率为70%,管理组总有效率是80.64%,对照组总有效率是40.62%,康复组和对照组比较差异明显(P<0.05),管理组和对照组比较差异也明显(P<0.05),康复组和管理组比较有显著差异(P<0.05)。康复组和管理组的体温恢复时间、咳嗽恢复时间、肺部啰音消失的时间均明显短于对照组(P<0.05)。管理组临床症状体征缓解时间与康复组比较差异明显(P<0.05)。康复组、管理组、对照组的吸入性肺炎发生率分别为43.33%、19.35%、62.5%,管理组与康复组和对照组比较差异明显(P<0.05)。结论后循环脑梗死急性期采用多种治疗手段对吞咽障碍进行管理,不仅可以有效改善吞咽功能障碍,同时缓解吸入性肺炎的症状,而且降低吸入性肺炎的发生率。

Objective To study the effect of the management of dysphagia with the acute posterior cir- culation infarction on aspiration pneumonia. Methods Ninety three patients with dysphagia of the acute poste- rior circulation infarction were randomly divided into three groups, 30 cases in rehabilitation instructing group, 31 cases in dysphagia management group and 32 cases in control group. Swallowing functional, the incidence of aspiration pneumonia and the improvement of aspiration pneumonia symptoms were observed after 4 weeks of treatment. Results After treatment the total efficiency rate of dysphagia improvement in rehabilitation in- structing group, dysphagia management group and control group was 70% , 80. 64% and 40. 62% ; there was significant statistics difference between rehabilitation instructing group and control group （P〈0. 05）, the total efficiency rate of dysphagia improvement in dysphagia management group was significantly higher than that in control group （P〈0. 05）, there was a statistically significant difference between rehabilitation instructing group and dysphagia management group （P〈0. 05）. Compared to control group,temperature returned to nor- mal, the disappearance time of cough, pulmonary tales disappeared time, in rehabilitation instructing group and management group were significantly reduced （P〈0. 05）. The time for the symptomatic relieve and improve- ment of physical signs also have significant difference between rehabilitation instructing group and dysphagia management group （P〈0. 05）. The incidence of aspiration pneumonia in rehabilitation instructing group, dys- phagia management group and control group was 43.33%, 19. 35% and 62. 5%, respectivly. There was sig- nificant statistics difference between dysphagia management group with rehabilitation instructing group and control group （P〈0. 05）. Conchlsions Dysphagia management can improve swallowing function in patients with posterior circulation infarction to relieve the symptoms of aspiration pneumonia and reduce the incidence of aspiration pneumonia.