多感官刺激联合间歇经口至食管管饲法在老年脑卒中吞咽障碍的应用

Application of multisensory stimulation combined with intermittent oroesophageal tube feeding in swallowing disorders of elderly stroke patients

目的观察多感官刺激联合间歇经口至食管管饲法在老年脑卒中吞咽障碍的应用效果。方法选择2021年2月至2022年10月收治的脑卒中吞咽障碍患者为研究对象,随机分为对照组、观察A组、观察B组,对照组在常规治疗基础上,采用鼻留置胃管管饲;观察A组在常规治疗基础上,采用间歇经口至食管管饲法;观察B组在观察A组基础上,加用多感官刺激方案。3组均干预8周,在干预前和干预8周后观察洼田饮水试验、标准吞咽功能评价量表(SSA)、吞咽困难生活质量量表(SWAL-QOL)、体质指数(BMI)、营养风险筛查表2002(NRS2002)以及舌骨喉复合体动度检查(舌骨上移距离、甲状软骨上移距离、舌骨前移距离、甲状软骨前移距离)。结果干预8周后,除对照组SWAL-QOL评分以外,其余3组洼田饮水试验、SSA评分和SWAL-QOL评分优于干预前(P<0.05)。而观察B组在洼田饮水试验与其余2组差异有统计学意义(P<0.05),SSA评分低于其余2组,SWAL-QOL评分高于对照组(P<0.05),与观察A组差异无统计学意义(P>0.05)。在营养情况方面,干预8周后3组BMI均高于干预前,NRS2002均低于干预前(P<0.05)。组间比较,3组BMI差异无统计学意义(P>0.05);在NRS2002方面,观察A组和观察B组均低于对照组(P<0.05),而观察A组和观察B组之间差异无统计学意义(P>0.05)。在喉复合体动度检查方面,干预8周后,除对照组舌骨上移距离,其余3组各项距离高于干预前(P<0.05)。观察B组舌骨上移距离、舌骨前移距离高于其余2组(P<0.05),甲状软骨前移距离、甲状软骨上移距离仅高于对照组,与观察A组差异无统计学意义(P>0.05)。结论多感官刺激联合间歇经口至食管管饲法作用于脑卒中吞咽障碍患者,能够改善患者的吞咽功能,提高生活质量,值得进一步研究。

Objective To assess the effectiveness of multisensory stimulation combined with intermittent oroe-sophageal tube feeding in managing swallowing disorders among elderly stroke patients.Methods Stroke patients with swallowing disorders from February 2021 to October 2022 were randomly allocated into control group,observation group A,and observation group B.The control group received nasal gastric tube feeding on top of routine treatment;observation group A received intermittent oroesophageal tube feeding as an adjunct to routine treatment;observation group B,building upon observation group A,incorporated a multisensory stimulation protocol.The intervention duration for all three groups was 8 weeks.The study evaluated the Penetration-Aspiration Scale(PAS),Standard Swallowing Assessment(SSA),Swallowing Quality of Life Questionnaire(SWAL-QOL),body mass index(BMI),Nutritional Risk Screening 2002(NRS2002),and laryngopharyngeal complex movement examination(hyoid bone elevation distance,thyroid cartilage ele-vation distance,hyoid bone anterior movement distance,thyroid cartilage anterior movement distance)before and after the intervention.Results After 8 weeks of intervention,except for the SWAL-QOL score in the control group,the PAS score,SSA score,and SWAL-QOL score in the three groups showed improvement compared to pre-intervention levels(P<0.05).Observation group B demonstrated a significant difference in the PAS test and a lower SSA score compared to the other two groups(P<0.05),with a higher SWAL-QOL score than the control group(P<0.05),and no significant difference from observation group A(P>0.05).Regarding nutritional aspects,after 8 weeks of intervention,the BMI of all three groups increased compared to pre-intervention levels,and NRS2002 decreased(P<0.05).In the intergroup comparison,there was no significant difference in BMI among the three groups(P>0.05).Concerning NRS2002,observation group A and observation group B had lower scores than the control group(P<0.05),with no significant difference between observation group A and observation group B(P>0.05).In the laryngopharyngeal complex movement examination,after 8 weeks of intervention,except for the hyoid bone elevation distance in the control group,all other distances in the three groups increased compared to pre-intervention levels(P<0.05).Observation group B had higher values than the other two groups in hyoid bone elevation distance and hyoid bone anterior movement distance(P<0.05),and only higher values than the control group in thyroid cartilage anterior movement distance and thyroid cartilage elevation distance,with no significant difference from observation group A(P>0.05).Conclusion The application of multisensory stimulation combined with intermittent oroesophageal tube feeding in stroke patients with swallowing disorders demonstrates improvements in swallowing function and enhances overall quality of life.Further research in this domain is warranted.