山莨菪碱联合地塞米松在急性缺血性脑卒中并吞咽障碍患者留置胃管中的应用效果

Application Effect of Anisodamine Combined with Dexamethasone in Gastric Intubation in Acute Ischemic Stroke Patients Complicated with Dysphagia

目的 分析山莨菪碱联合地塞米松在急性缺血性脑卒中并吞咽障碍患者留置胃管中的应用效果。方法 选取2017年8月—2018年12月于河北工程大学附属医院留置胃管的急性缺血性脑卒中并吞咽障碍患者90例,采用随机数字表法分为对照组和观察组,每组45例。对照组患者给予山莨菪碱后5min留置胃管,观察组患者给予山莨菪碱5min后给予地塞米松并于5min后留置胃管。比较两组患者插管前30min及插管后30min心率、血压(收缩压、舒张压)及血氧饱和度(SpO2),一次插管成功率,插管过程中并发症发生情况(包括呕吐、恶心、呛咳、流泪、抽搐及胃痉挛),留置胃管1、7、21d洼田饮水试验分级。结果 (1)插管前30min两组患者心率、收缩压、舒张压、SpO2比较,差异无统计学意义(P>0.05);插管后30min观察组患者心率、收缩压、舒张压低于对照组,SpO2高于对照组(P<0.05)。(2)观察组患者一次插管成功率高于对照组(P<0.05)。(3)插管期间观察组患者呕吐、恶心、呛咳发生率低于对照组(P<0.05);两组患者流泪、抽搐、胃痉挛发生率比较,差异无统计学意义(P>0.05)。(4)观察组患者留置胃管1、7、21d洼田饮水试验分级优于对照组(P<0.05)。结论 山莨菪碱联合地塞米松可有效降低急性缺血性脑卒中并吞咽障碍患者留置胃管过程中心率、血压及呕吐、恶心、呛咳发生率,提高一次插管成功率,改善患者吞咽功能。

Objective To analyze the application effect of anisodamine combined with dexamethasone in gastric intubation in acute ischemic stroke patients complicated with dysphagia. Methods A total of 90 acute ischemic stroke patients complicated with dysphagia were selected in the Affiliated Hospital of Hebei University of Engineering from August 2017 to December 2018,all of them received gastric intubation,and they were divided into control group and observation group according to random number table method,with 45 cases in each group. Patients in control group received gastric intubation 5 minute after usage of anisodamine,while patients in observation group received gastric intubation 5 minute after usage of dexamethasone that 5 minute after usage of anisodamine. Heart rate,SBP,DBP and SpO2 30 minutes before intubation and 30 minutes after intubation,success rate of first intubation,incidence of complications during intubation process(including emesis,nausea,irritating cough,lachrymation,tic and gastro spasm),Water swallow test grading 1 day,7 and 21 days after gastric intubation were compared between the two groups. Results (1)No statistically significant difference of heart rate,SBP,DBP or SpO2 was found between the two groups 30 minutes before intubation(P>0.05);30 minutes after intubation,heart rate,SBP and DBP in observation group were statistically significantly lower than those in control group, while SpO2 in observation group was statistically significantly higher than that in control group(P<0.05).(2)Success rate of first intubation in observation group was statistically significantly higher than that in control group(P<0.05).(3)Incidence of emesis,nausea and irritating cough in observation group was statistically significantly lower than that in control group during intubation process,respectively(P<0.05),while no statistically significant difference of lachrymation,tic or gastro spasm was found between the two groups(P>0.05).(4)Water swallow test grading in observation group was statistically significantly better than that in control group 1 day,7 and 21 days after gastric intubation,respectively(P<0.05). Conclusion In gastric intubation in acute ischemic stroke patients complicated with dysphagia,anisodamine combined with dexamethasone can effectively reduce the heart rate,blood pressure,incidence of emesis,nausea and irritating cough,improve the success rate of first intubation and swallowing function.