间歇经口至食管管饲在急性卒中合并吞咽障碍患者中的应用研究

The Application of Intermittent Oro-Esophageal Tube Feeding in Acute Stroke Patients with Dysphagia

目的探讨间歇经口至食管管饲(intermittent oro-esophageal tube feeding,IOE)在急性卒中合并吞咽障碍患者中的应用效果。方法本研究为前瞻性随机对照研究,连续纳入2018年1月-2020年9月南京大学医学院附属鼓楼医院急诊科收治的急性卒中合并吞咽障碍患者,使用分层随机化方式将患者分为鼻饲组和IOE组。采用洼田饮水试验和标准吞咽功能评价量表(standardized swallowing assessment,SSA)分别在入院时及出院时对患者吞咽障碍进行评估,同时记录患者BMI、血红蛋白(hemoglobin,Hb)、血清白蛋白(albumin,ALB)及血清前白蛋白(prealbumin,PA)的变化,住院期间吸入性肺炎、消化性溃疡、便秘、腹泻、呕吐及口鼻黏膜破损的发生情况,以及住院天数等,比较两组上述指标的差异。结果符合纳入标准并进行分析的患者共126例,鼻饲组62例,IOE组64例。出院时IOE组吞咽功能临床疗效评级1级和2级的患者比例高于鼻饲组,但差异无统计学意义;IOE组SSA评分改善优于鼻饲组(24.88±3.07分vs 28.87±3.04分,P<0.001)。营养状况方面,出院时IOE组ALB(37.40±4.40 g/L vs 35.31±3.32 g/L,P=0.003)、PA(0.28±0.04 g/L vs 0.24±0.03 g/L,P<0.001)及Hb(127.60±6.93 g/L vs 124.76±6.69 g/L,P=0.021)均显著优于鼻饲组;IOE组患者吸入性肺炎(4.69%vs 22.58%,P=0.007)、呕吐(3.13%vs 25.81%,P=0.001)及口鼻黏膜破损(0 vs 17.74%,P=0.001)的发生率及住院天数(中位数15 d vs 17 d,P=0.029)也显著低于鼻饲组。结论 IOE可改善急性卒中合并吞咽障碍患者的吞咽功能,在提供良好营养支持的同时可降低吸入性肺炎、呕吐及口鼻黏膜破损的发生,值得临床推广。

Objective To evaluate the application effacy of intermittent oro-esophageal tube feeding(IOE)in acute stroke patients with dysphagia.Methods This prospective randomized controlled trial enrolled acute stroke patients complicated with dysphagia who were admitted to Department of Emergency of Nanjing Drum Tower Hospital from January 2018 to September 2020.All the patients were randomly divided into nasogastric feeding group and IOE group.Water swallow test and standardized swallowing assessment(SSA)were used to evaluate the swallowing function of all the patients at admission and discharge.The BMI,hemoglobin(Hb),albumin(ALB)and prealbumin(PA)of all the patients were collected.Meanwhile,the length of stay,aspiration pneumonia,peptic ulcer,constipation,diarrhea,vomiting and mucosa injury of mouth and nose were compared between the two groups.Results 126 acute stroke patients were included for analysis finally,with 62 cases in nasogastric feeding group and 64 in IOE group.Although the number of patients with dysphagia grade 1 and 2 in IOE group was higher than that in nasogastric feeding group at discharge,there was no statistical difference.The improvement of SSA score in IOE group was better than that in nasogastric feeding group(24.88±3.07 vs 28.87±3.04,P<0.001).For nutritional state,the level of ALB(37.40±4.40 g/L vs 35.31±3.32 g/L,P=0.003),PA(0.28±0.04 g/L vs 0.24±0.03 g/L,P<0.001)and Hb(127.60±6.93 vs 124.76±6.69 g/L,P=0.021)were all higher in IOE group than in nasogastric feeding group at discharge;the incidence of aspiration pneumonia(4.69%vs 22.58%,P=0.007),vomiting(3.13%vs 25.81%,P=0.001)and mucosa injury of mouth and nose(0 vs 17.74%,P=0.001)and the length of stay(median:15 days vs 17 days,P=0.029)in IOE group were all lower than that in nasogastric feeding group.Conclusions IOE could provide appropriate nutrition support and improve swallowing function in acute stroke patients with dysphagia,and reduce the incidence of the complications of aspiration pneumonia,vomiting and mucosa injury of mouth and nose.