GUSS量表作为缺血性脑卒中患者留置胃管拔管指征的效果评价

Value of Gugging swallowing screen (GUSS)for evaluating the timing for extubation of gastric tube in ischemic stroke patients with dysphasia

目的探讨Gugging吞咽功能评估量表(gugging swallowing screen,GUSS)与洼田饮水试验在缺血性脑卒中伴吞咽障碍患者留置胃管拔管标准中的应用价值。方法选取2017年1月-2018年4月入住首都医科大学附属北京天坛医院急诊科的缺血性脑卒中伴吞咽困难留置胃管患者180例,随机分为观察A组(60例)、观察B组(60例)和对照组(60例)三组。观察组均采用Gugging吞咽功能评估量表筛查患者吞咽功能,观察A组予15≤GUSS<20分拔除胃管开始经口喂养,观察B组予GUSS评分=20分拔除胃管开始经口喂养;对照组予洼田饮水试验筛查患者吞咽功能,在拔管30 d时比较三组患者的胃管复插率、吸入性肺炎发生率及营养不良发生率。结果观察组胃管复查率、吸入性肺炎发生率均低于对照组(P<0.05),营养不良发生率差异无统计学意义(P>0.05);观察A组和观察B组胃管复查率、吸入性肺炎发生率及营养不良发生率差异无统计学意义(P>0.05)。结论Gugging吞咽功能评估量表作为缺血性脑卒中伴吞咽障碍患者留置胃管拔管标准优于洼田饮水试验;15≤GUSS评分<20分时拔除患者的胃管或GUSS评分=20分时拔除胃管,胃管复插率、吸入性肺炎及营养不良发生率方面无差异。

Objective To investigate the value of GUSS on evaluating the timing for extubation of gastric tube in ischemic stroke patients with dysphasia.Methods One hundred and eighty ischemic stroke patients with dysphagia indwelling gastric tube from January 2017 to April 2018 in emergency department were admitted.Patients were randomly divided into three groups.Two observation group used 15≤GUSS<20 or GUSS=20 as the indication of extubation of gastric tube separately,while the control group used drinking water test.The incidence of reintubation of the gastric tube ,neumonia and malnutrition were compared among three groups after 3 months.Results The incidence of reintubation of the gastric tube and pneumonia in 2 observation groups were lower than that of control group(P < 0.05).There was no statistical difference in the rate of malnutrition among 3 groups.Conclusion GUSS was better than the water swallow test for evaluating the timing for extubation of gastric tube in ischemic stroke patients with swallowing disorders.The influence of different points of GUSS on the outcomes of extubation of gastric tube was not found in this study.