获得性颅脑损伤患者进食评定方法的改进研究

A research on improving the food intake assessment method in acquired brain injury patients

目的将反复唾沫吞咽试验、标准吞咽功能评定量表联合食物容积黏度测试应用于获得性颅脑损伤患者,识别获得性颅脑损伤患者恢复期经口进食过程中潜在的风险,改进误吸预防策略。方法收集2016年11月至2017年11月住院的142例获得性颅脑损伤患者作为观察组,2015年10月至2016年10月住院的153例获得性颅脑损伤患者作为对照组。对照组只采用洼田饮水试验进行评估,观察组采用反复唾沫吞咽试验、标准吞咽功能评定、食物容积黏度测试进行综合动态评估,直至患者出院。观察比较2组误吸风险检出率和吸入性肺炎发生率。结果观察组误吸风险检出率36.6%(52/142),高于对照组的7.8%(12/153),差异有统计学意义(χ^2=35.899,P<0.05),观察组吸入性肺炎发生率1.4%(2/142),低于对照组的12.4%(19/153),差异有统计学意义(χ^2=13.502,P<0.05)。结论反复唾沫吞咽试验、标准吞咽功能评定与食物容积黏度测试联合应用能提高神经外科获得性颅脑损伤患者误吸风险的检出率,降低吸入性肺炎的发生率,提高护理安全性,改善患者的健康结局。

Objective To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury,we aim to identify the potential risks of oral intake during the patients′ recovery stage,and improve the strategy of aspiration prevention.Methods Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017,and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016.The control group was assessed by water swallow test,while a combination of the Repetitive Saliva Swallowing Test,the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging.The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups.Results The detection rate of aspiration risk was 36.6%(52/142)in the observation group and 7.8%(12/153)in the control group,the difference was statistically significant(χ^2=35.899,P<0.05).The incidence of aspiration pneumonia was 1.4%(2/142)in the observation group and 12.4%(19/153)in the control group,the difference was statistically significant(χ^2=13.502,P<0.05).Conclusions The combined application of the Repetitive Saliva Swallowing Test,the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired-brain-injury patients with suspicious swallowing dysfunction,reduce the incidence of aspiration pneumonia,increase the nursing safety,and improve the health outcomes of neurosurgical patients.