老年慢性阻塞性肺疾病患者吞咽障碍发生现状及影响因素分析

Analysis on the status and influencing factors of dysphagia in elderly patients with chronic obstructive pulmonary disease

目的调查老年COPD患者发生吞咽障碍的现状及其影响因素。方法采用便利抽样法,2019年4月—2020年8月,选取宁夏回族自治区13所综合医院呼吸内科住院老年COPD患者1268例,使用一般资料调查表、洼田饮水试验、改良英国医学研究委员会呼吸困难评级量表、日常生活能力评估量表、老年人抑郁量表、微型营养评定法简版、慢性阻塞性肺疾病评价测试量表、衰弱筛查量表对患者进行调查,单因素分析有统计学意义的变量进行Logistic回归分析,分析COPD患者发生吞咽障碍的影响因素。结果回收有效问卷1128份。老年COPD患者吞咽障碍发生率为20.39%,Logistic回归分析显示,吸烟情况、牙齿缺失、集中注意力进食、进食体位、二氧化碳分压、呼吸困难程度、营养状况及COPD严重程度是老年COPD患者吞咽障碍的影响因素(P<0.05)。结论老年COPD患者吞咽障碍发生率较高,病情严重,呼吸困难程度高,二氧化碳分压高、长期吸烟、牙齿缺失数量≥6颗、营养不良、未集中注意力进食、半卧位进食的COPD患者,其吞咽障碍的发生风险较高。临床护理人员可根据影响因素制订相关护理措施,预防吞咽障碍的发生。

Objective To investigate the status and influencing factors of dysphagia in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 1268 elderly patients with COPD hospitalized in the respiratory department of 13 general hospitals in Ningxia were selected by convenience sampling method from April 2019 to August 2020.Patients were investigated by the general information questionnaire,the Water Swallowing Test,Modified Medical Research Council Dyspnea Scale,Activities of Daily Living,the Geriatric Depression Scale,the Mini Nutritional Assessment-Short Form,COPD Assessment Test Scale,the FRAIL debilitation assessment scale.Logistic regression analysis was performed to analyze the influencing factors of dysphagia in COPD patients with statistically significant variables.Results The incidence of dysphagia in elderly COPD patients was 20.39%.Logistic regression analysis showed that smoking status,tooth loss,feeding attention,feeding position,PaCO2,dyspnea,nutritional status and COPD severity were the influential factors of dysphagia(P<0.05).Conclusion The incidence of dysphagia in elderly COPD patients is higher.COPD patients with severe disease,high degree of dyspnea,high PaCO2,long-term smoking,number of missing teeth≥6,malnutrition,not paying attention to eating,and semi-recumbent position have a higher risk of dysphagia.Clinical medical staff can formulate relevant intervention measures according to the influencing factors to prevent the occurrence of dysphagia.