间歇经口至食管管饲联合吞咽训练对脑卒中吞咽障碍患者营养状态和预后的影响

Effect of intermittent oral to esophageal tube feeding combined with swallowing training on nutritional status and prognosis in stroke patients with dysphagia

目的分析间歇经口至食管管饲联合吞咽训练对吞咽障碍患者营养状态和预后的影响。方法前瞻性选取邢台市第三医院康复科自2019年1月至2020年5月收治的106例吞咽障碍患者,采用随机数字表法分为对照组和研究组,每组53例。对照组给予持续留置鼻饲+吞咽训练,研究组采用间歇经口至食管管饲+吞咽训练,均治疗4周。对比2组患者治疗前后的吞咽功能、营养状态[包括体质量指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂围(AC)、血清总蛋白(TP)、血清前白蛋白(PA)、血清白蛋白(ALB)]和临床疗效,以及治疗期间并发症、不良事件发生率和预后。结果2组患者治疗前后吞咽功能等级比较差异均有统计学意义(P<0.05),且治疗后组间比较差异有统计学意义(P<0.05)。研究组治疗后BMI、TSF、AC和血清TP、PA、ALB水平均高于治疗前,且均高于对照组,差异均有统计学意义(P<0.05)。研究组临床疗效分布与对照组比较差异有统计学意义(P<0.05);研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。研究组误吸、吸入性肺炎、电解质紊乱发生率及并发症发生率均低于对照组,差异均有统计学意义(P<0.05)。2组患者不良事件发生率比较,差异无统计学意义(P>0.05)。研究组NIHSS评分低于对照组,BI评分高于对照组,差异均有统计学意义(P<0.05)。结论间歇经口至食管管饲联合吞咽训练可显著改善吞咽障碍患者的吞咽功能、营养状态,增强疗效,还可减少并发症,改善预后。

Objective To analyze the effect of intermittent oral to esophageal tube feeding combined with swallowing training on nutritional status and prognosis of patients with dysphagia.Methods One hundred and six patients with dysphagia in the Third Hospital of Xingtai City from January 2019 to May 2020 were divided into control group(53 cases,continuous indwelling nasal feeding+swallowing training)and study group(53 cases,intermittent oral to esophageal tube feeding+swallowing training)by a random digital table,and all patients were treated for 4 weeks.The swallowing function,nutritional status[including body mass index(BMI),triceps skinfold thickness(TSF),arm circumference(AC),total protein(TP),prealbumin(PA),albumin(ALB)]before treatment and after treatment were compared between the two groups.The clinical effect,the incidences of complications and adverse events during treatment and prognosis were compared.Results There were statistically significant differences in swallowing function grades between the two groups before and after treatment(P<0.05),and there was a statistically significant difference between the two groups after treatment(P<0.05).After treatment,BMI,TSF,AC,serum TP,PA,ALB levels in the study group were higher than those before treatment,which were higher than those in the control group,with statistically significant differences(P<0.05).There was a statistically significant difference in the grading of clinical effect between the two groups after treatment(P<0.05),and the total effective rate in the study group was higher than the control group(P<0.05).The incidences of aspiration pneumonia,electrolyte disturbance and complications were lower than those of the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidences of adverse events between the two groups(P>0.05).NIHSS score of the study group was lower than that of the control group,and BI score was higher than that of the control group,with a statistically significant difference(P<0.05).Conclusion Intermittent oral to esophageal tube feeding combined with swallowing training can significantly improve the swallowing function and nutritional status of patients with dysphagia,enhance clinical effect,reduce complications and improve the prognosis.