间歇经口至食管管饲在痴呆伴吞咽障碍患者中的应用

Application of intermittent oro-esophageal tube feeding in dementia patients with dysphagia

目的探讨痴呆伴吞咽困难患者应用间歇经口至食管管饲的临床效果。方法选择2015年3月至2017年10月开封市中心医院收治的痴呆伴吞咽障碍患者62例为研究对象,所有患者给予低频电刺激、压力和温度刺激、针灸等吞咽功能康复治疗,其中30例给予间歇经口至食管管饲营养支持(观察组),32例仅接受康复治疗和人工喂食,不应用间歇经口至食管管饲(对照组)。对2组患者治疗前及治疗3个月后简易智力状态检查量表(MMSE)评分、吞咽功能、营养指标、每次进食时间及不良反应进行比较。结果治疗前2组患者MMSE评分、每次进食时间、体质量指数(BMI)及血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)水平比较差异均无统计学意义(P> 0. 05)。观察组患者治疗后MMSE评分、BMI及Hb、TP、ALB水平显著高于治疗前,每次进食时间显著短于治疗前(P <0. 05)。对照组患者治疗后BMI及Hb、TP、ALB水平显著高于治疗前,每次进食时间显著短于治疗前(P <0. 05);但对照组患者治疗前后MMSE评分比较差异无统计学意义(P> 0. 05)。治疗后,观察组患者BMI及Hb、TP、ALB水平显著高于对照组,每次进食时间显著短于对照组(P <0. 05);但治疗后2组患者MMSE评分比较差异无统计学意义(P> 0. 05)。治疗后,观察组和对照组患者吞咽功能治疗总有效率分别为83. 3%(25/30)、59. 4%(19/32),观察组患者吞咽功能治疗总有效率显著高于对照组(χ~2=4. 314,P <0. 05)。观察组和对照组患者吸入性肺炎发生率分别为13. 3%(4/30)、37. 5%(12/32),观察组患者吸入性肺炎发生率显著低于对照组(χ~2=4. 723,P <0. 05)。结论间歇经口至食管管饲可以显著改善痴呆伴吞咽障碍患者的营养状况,促进吞咽功能恢复,降低并发症发生率。

Objective To investigate the clinical effect of intermittent oro-esophageal tube feeding in dementia patients with dysphagia.Methods Sixty-two dementia patients with dysphagia in Kaifeng Central Hospital from March 2015 to October 2017 were selected as subjects.All the patients were given low-frequency electrical stimulation,pressure and temperature stimulation,acupuncture and other swallowing function rehabilitation treatment.Among the patients,30 patients were given intermittent oro-esophageal tube feeding （observation group）;32 patients received only rehabilitation treatment and artificial feeding,but they did not received intermittent oro-esophageal tube feeding （control group）.The scores of mini-mental state examination（MMSE）,swallowing function,nutritional index,each feeding time and adverse reaction were compared between the two groups before and after treatment for three months.Results There was no significant difference in MMSE score,each feeding time,body mass index （BMI） and the levels of hemoglobin （Hb）,total protein （TP） and albumin （ALB） between the two groups before treatment （ P 〉0.05）.The MMSE score,BMI and the levels of Hb,TP and ALB after treatment were significantly higher than those before treatment,and the each feeding time after three months of treatment was significantly shorter than that before treatment in the observation group （ P 〈0.05）.The BMI and the levels of Hb,TP and ALB after treatment were significantly higher than those before treatment,and the each feeding time after treatment was significantly shorter than that before treatment in the control group （ P 〈0.05）.There was no significant difference in MMSE score before and after treatment in the control group （ P 〉0.05）.The BMI and the levels of Hb,TP and ALB in the observation group were significantly higher than those in the control group after treatment,and the each feeding time in the observation group was significantly shorter than that in the control group （ P 〈0.05）.There was no significant difference in the MMSE score between the two groups after treatment （ P 〉0.05）.The total effective rate of swallowing function treatment in the observation group and control group after three months of treatment was 83.3% （25/30） and 59.4% （19/32）,respectively.The total effective rate of swallowing function treatment in the observation group was significantly higher than that in the control group （ χ 2=4.314, P 〈0.05）.The incidence of aspiration pneumonia in the observation group and control group was 13.3% （4/30） and 37.5% （12/32）,respectively.The incidence of aspiration pneumonia in the observation group was significantly lower than that in the control group （ χ 2=4.723, P 〈0.05）.Conclusion Intermittent oro-esophageal tube feeding can significantly improve the nutritional status of dementia patients with dysphagia,promote the recovery of swallowing function,and reduce the incidence of complications.