吞咽功能训练与鼻饲泵对急性脑梗死继发吞咽功能障碍患者的效果观察

Effect of swallowing function training and nasal feeding pump for patients with swallowing functional disturbance secondary to acute cerebral infarction

目的探讨急性脑梗死(ACI)继发吞咽功能障碍(SFD)患者应用吞咽功能训练联合鼻饲泵的护理效果。方法选取2019年11月至2020年11月期间郑州大学第一附属医院收治的ACI继发SFD患者109例为研究对象,按照随机数字表法分为对照组54例与观察组55例。对照组男33例,女21例,年龄(65.87±10.64)岁;观察组男36例,女19例,年龄(66.12±9.39)岁。对照组给予吞咽功能训练,观察组在对照组基础上联合鼻饲泵干预。比较干预前、干预4周后,两组患者吞咽障碍程度[吞咽障碍造影评分量表(VDS)]、摄食情况[功能性经口摄食量表(FOIS)]、生活质量[吞咽障碍特异性生活质量量表(SWAL-QOL)]差异;分析两组患者并发症发生情况。结果干预4周后,观察组的VDS口腔期评分、咽期评分、总分分别为(13.02±3.01)分、(29.37±9.31)分、(54.79±12.52)分,对照组为(25.42±8.36)分、(33.13±10.36)分、(61.96±13.89)分,观察组均显著低于同期对照组(均P<0.05);且两组干预4周后各项评分均低于同组干预前(均P<0.05)。干预4周后,观察组的FOIS评分高于对照组[(3.33±1.19)分比(2.89±1.03)分],差异有统计学意义(P<0.05)。干预4周后,观察组SWAL-QOL中的进食时间、食欲、食物选择、症状频次维度评分均高于对照组[(16.36±2.36)分比(13.09±2.21)分、(14.63±1.61)分比(12.03±1.15)分、(17.36±1.56)分比(14.06±1.59)分、(16.96±1.32)分比(13.62±1.23)分],且两组干预4周后各项评分均较同组干预前显著上升,差异均有统计学意义(均P<0.05)。观察组并发症总发生率为9.10%(5/55),对照组为16.67%(9/54),两组比较差异无统计学意义(χ^(2)=1.397,P=0.237)。结论吞咽功能训练联合鼻饲泵可有效缓解ACI患者SFD程度,恢复摄食能力,改善生活质量。

Objective To explore the nursing effect of swallowing function training combined with nasal feeding pump for patients with swallowing functional disturbance(SFD)secondary to acute cerebral infarction(ACI).Methods A total of 109 patients with SFD secondary to ACI treated in The First Affiliated Hospital of Zhengzhou University between November 2019 and November 2020were selected as the research objects,andwere divided into a control group(54 cases)and an observation group(55 cases)by the random number table method.In control group,there were 33males and 21 females,with an age of(65.87±10.64).In observation group,therewere 36males and 19 females,with an age of(66.12±9.39).The control group did swallowing function training;in addition,the observation group took nasal feeding pump intervention.The dysphagia degrees[Videofluoroscopic Dysphagia Scale(VDS)],food intake[Functional Oral Intake Scale(FOIS)],and quality of life[Swallowing Quality of Life Questionnaire(SWAL-QOL)]were compared between the two groups before and 4 weeks after the intervention.The complications were analyzed in the two groups.Results Four weeks after the intervention,the VDS scores during oral and laryngopharynx periods and the total score were(13.02±3.01),(29.37±9.31),and(54.79±12.52)in the observation group,and were(25.42±8.36),(33.13±10.36),and(61.96±13.89)in the control group(all P<0.05);the scores in both groups were lower 4 weeks after than before the intervention(all P<0.05).Four weeks after the intervention,the score of FOIS and the scores of food-intake time,appetite,food choosing,and symptom frequency of SWAL-QOL in the observation group were higher than those in the control group[(3.33±1.19)vs.(2.89±1.03),(16.36±2.36)vs.(13.09±2.21),(14.63±1.61)vs.(12.03±1.15),(17.36±1.56)vs.(14.06±1.59),and(16.96±1.32)vs.(13.62±1.23);all P<0.05].The scores of SWAL-QOL in both groups were higher 4 weeks after than before the intervention(all P<0.05).The total incidence of complications in the observation group was not significantly different from that in the control group[9.10%(5/55)vs.16.67%(9/54);χ^(2)=1.397,P=0.237].Conclusion Swallowing function training combined with nasal feeding pump can effectively alleviate the SFD degree of patients with ACI,restore food intake,and improve their quality of life.