间歇性置管鼻饲法在脑卒中后咽期吞咽障碍患者的吞咽功能改善的疗效观察

Improvement of swallowing function in patients with dysphagia in post-stroke pharynx by nasal feeding through intermittent oral gastric tube

目的:研究脑卒中后咽期吞咽障碍患者应用经口间歇胃管置管鼻饲法对改善吞咽功能的疗效。方法:选取广东省第二人民医院康复医学科2018年9月-2019年12月收治的70例脑卒中后咽期吞咽障碍患者为研究对象,以等距随机抽样法分为对照组与观察组,每组35例,对照组常规留置胃管,观察组采取经口间歇胃管置管鼻饲法,对比两组吞咽功能分级、营养状态(体质量、血红蛋白、肱三头肌皮褶厚度)、并发症发生率。结果:干预前两组吞咽功能分级相比较,差异无统计学意义(P>0.05),干预后观察组吞咽功能分级与对照组相比较,差异有统计学意义(P<0.05);干预前两组营养状态相比较,差异无统计学意义(P>0.05),干预后与干预前相比较,差异有统计学意义(P<0.05);观察组干预后营养状态与对照组相比较,差异有统计学意义(P<0.05);观察组胃食管反流/误吸发生率2.86%(1/35)、肺部感染发生率0.00%(0/35)、腹泻发生率2.86%(1/35)、鼻咽部溃疡/食管胃黏膜糜烂发生率2.86%(1/35),均分别小于对照组11.43%(4/35)、8.57%(3/35)、14.29%(5/35)、14.29%(5/35),差异有统计学意义(P<0.05)。结论:脑卒中后咽期吞咽障碍患者应用经口间歇胃管置管鼻饲法取得的吞咽功能改善效果更为理想,值得在今后工作中推广使用。

Objective:To study the effect of nasal feeding with intermittent oral gastric tube intubation on the improvement of swallowing function in patients with dysphagia after stroke.Methods:Seventy patients with pharyngeal dysphagia after stroke in the Department of Rehabilitation Medicine of the Second People's Hospital of Guangdong Province from September 2018 to December 2019 were selected as the research subjects.They were divided into the control group and the observation group by isometric random sampling.There were 35 cases in each group.The control group routinely indwelled gastric tubes.The observation group received oral intermittent gastric tube nasal feeding,the swallowing function grade,nutritional status(weight,hemoglobin,triceps brachial fold thickness)and incidence of disease of two groups were compared.Results:There was no significant difference in the swallowing function classification between the two groups before intervention(P>0.05),and there was a statistically significant difference between the observation group and the control group after intervention(P<0.05);the two groups were compared in the nutritional status before intervention,the difference was not statistically significant(P>0.05).After intervention,the difference was statistically significant(P<0.05);The incidence of gastroesophageal reflux/aspiration,pulmonary infection,diarrhea,and nasopharynx ulcer/gastroesophageal mucosal erosion in the observation group were 2.86%(1/35),0.00%(0/35),2.86%(1/35),and 2.86%(1/35),which were lower than those in the control group[11.43%(4/35),8.57%(3/35),14.29%(5/35),and 14.29%(5/35)](P<0.05).Conclusion:The effect of nasal feeding with intermittent oral gastric tube intubation in patients with dysphagia after stroke is better,and it is worth popularizing in the future work.