电视荧光吞咽功能检查及预见性治疗对脑卒中后并发吸入性肺炎的影响

Effect of videofloroscopic swallowing study and predictive treatment on aspiration pneumonia after stroke

目的探讨电视荧光吞咽功能检查(VFSS)及预见性治疗对脑卒中后并发吸入性肺炎的影响。方法前瞻性选取2017年4月至2019年5月海南医学院第二附属医院收治的98例脑卒中患者,应用简单随机化分组方法分为:对照组和观察组,每组各49例。对照组患者给予常规干预,观察组患者在此基础上予以VFSS检查及预见性治疗。比较两组患者的吸入性肺炎发生率、吞咽功能变化、误吸风险、营养指标(血清总蛋白、血红蛋白、白蛋白、体重指数)、吞咽障碍特异性生活质量量表(SWAL-QOL)评分、护理满意度。结果观察组患者吸入性肺炎的发生率(0)低于对照组(12.24%),差异具有统计学意义(P<0.05);观察组患者干预后口腔期、咽喉期、食管期VFSS检查评分(2.71±0.13分,2.61±0.13分,3.53±0.24分)高于对照组(2.26±0.10分,2.14±0.17分,2.97±0.20分),差异均有统计学意义(P<0.05);观察组患者干预后误吸风险率(6.12%)低于对照组(26.53%),差异有统计学意义(P<0.05);观察组患者干预后血清总蛋白(64.23±5.05 g/L)、血红蛋白(120.28±15.54 g/L)、白蛋白(39.02±5.37 g/L)高于对照组(60.19±4.92 g/L,113.17±13.29 g/L,35.44±4.18 g/L),差异均有统计学意义(P<0.05);观察组患者干预后睡眠(26.72±5.11分)、疲劳(23.49±8.27分)、社会交往(21.11±6.39分)、心理健康(10.19±2.33分)、恐惧(12.65±4.19分)、语言交流(10.77±9.02分)、食物选择(13.90±2.26分)、心理负担(6.88±1.39分)、食欲(15.07±4.85分)、症状频率(8.56±1.76分)、进食时间(19.37±7.44分)SWAL-QOL评分均低于对照组(40.91±8.25、38.29±7.11、42.35±6.86、20.47±5.83、24.60±6.55、22.83±9.34、20.78±3.61、16.43±2.77、22.27±3.91、15.68±2.80、26.59±8.12分),差异有统计学意义(P<0.05);观察组患者的护理满意度(91.84%)高于对照组(63.27%),差异有统计学意义(P<0.05)。结论VFSS联合预见性治疗能改善脑卒中患者吞咽功能,降低误吸风险,改善患者营养状态,降低吸入性肺炎发生率,提高护理满意度与生活质量。

Objective To investigate the effects of videofloroscopic swallowing study(VFSS)and predictive treatment on aspiration pneumonia after stroke.Methods 98 stroke patients admitted to the Second Affiliated Hospital of Hainan Medical College from April 2017 to May 2019 were prospectively selected,and randomly divided into two groups:the control group and the observation group,with 49 cases in each group.The control group was given conventional intervention,and the observation group was given VFSS and predictive treatment on the basis of conventional intervention.The incidence of aspiration pneumonia,changes in swallowing function,risk of aspiration,nutritional indicators(total serum protein,hemoglobin,albumin,body mass index),swallowing quality of life questionnaire(SWAL-QOL)and satisfactory of nursing were compared between the two groups.Results The incidence of aspiration pneumonia in the observation group(0)was lower than that in the control group(12.24%),the difference was statistically significant(P<0.05);the scores of the VFSS(2.71±0.13 points,2.61±0.13 points,3.53±0.24 points)in the oral,throat,and esophageal phases in the observation group were higher than those in the control group(2.26±0.10 points,2.14±0.17 points,2.97±0.20 points)after intervention,the difference was statistically significant(P<0.05);the risk of aspiration in the observation group(6.12%)was lower than that in the control group(26.53%)after intervention,the difference was statistically significant(P<0.05);the total serum protein(64.23±5.05 g/L),hemoglobin(120.28±15.54 g/L),and albumin(39.02±5.37 g/L)in the observation group were higher than those in the control group(60.19±4.92 g/L,113.17±13.29 g/L,35.44±4.18 g/L)after intervention,the differences were statistically significant(P<0.05);the SWAL-QOL scores of sleep(26.72±5.11 points),fatigue(23.49±8.27 points),social functioning(21.11±6.39 points),mental health(10.19±2.33 points),fear(12.65±4.19 points),communication(10.77±9.02 points),food selection(13.90±2.26 points),burden(6.88±1.39 points),eating desire(15.07±4.85 points),symptom frequency battery(8.56±1.76 points),and eating duration(19.37±7.44 points)in the observation group were lower than those in the control group after intervention(40.91±8.25,38.29±7.11,42.35±6.86,20.47±5.83,24.60±6.55,22.83±9.34,20.78±3.61,16.43±2.77,22.27±3.91,15.68±2.80,26.59±8.12 points),the differences were statistically significant(P<0.05);the satisfactory of nursing in the observation group(91.84%)was higher than that in the control group(63.27%),the difference was statistically significant(P<0.05).Conclusion VFSS combined with predictive treatment can improve the swallowing function of stroke patients,reduce the risk of aspiration,improve the nutritional status of patients,reduce the incidence of aspiration pneumonia,and improve nursing satisfaction and quality of life.