脑卒中后吞咽障碍患者吸入性肺炎危险因素及洼田饮水试验应用进展

Advances in the risk factors of aspiration pneumonia in stroke patients with dysphagia and in application of Kubota drinking water test

吞咽障碍是脑卒中后常见并发症之一,最主要的危害是误吸渗漏,易致吸入性肺炎,引起神经功能严重损伤,甚至危及生命。本研究旨在分析脑卒中后吞咽障碍患者发生吸入性肺炎的危险因素,并通过文献观察洼田饮水试验筛查应用现状,为临床应用提供依据。通过对中国知网、万方、维普、PubMed和Web of Science等中英文数据库,以'脑卒中''吞咽障碍'和'吸入性肺炎'为关键词,检索2014-01-01-2018-12-31相关文献。纳入标准:(1)脑卒中后吞咽障碍合并吸入性肺炎;(2)吸入性肺炎的危险因素;(3)洼田饮水试验。剔除标准:(1)综述类文献;(2)研究资料缺失或质量较差。最终37篇文献纳入分析。文献研究发现,脑卒中后吞咽障碍发生吸入性肺炎的危险因素主要包括鼻胃管留置、气管切开、双侧大脑病变和脑干病变等。脑卒中后吞咽障碍引发吸入性肺炎患者进行洼田饮水试验筛查能够对进食进水等起到指导反馈作用,应用洼田饮水试验再进行吞咽障碍训练能够降低吸入性肺炎发生率。提示,脑卒中后吞咽障碍发生吸入性肺炎的危险因素较多,洼田饮水试验能够指导吞咽障碍训练,减低吸入性肺炎发生率。

Dysphagia is one of the common complications after stroke.The most important hazard is aspiration and leakage,which is easy to cause aspiration pneumonia,resulting in serious damage to nerve function and even life-threatening.This review aims to analyze the risk factors of aspiration pneumonia in stroke patients with pharyngeal dysfunction,and to observe the current status of the application of the Kubota drinking water test,and provide a basis for clinical application.Through the Chinese and English databases such as China National Knowledge Infrastructure,Wanfang,Weipu,PubMed and Web of Science,the words'stroke'',swallowing disorder'and'aspiration pneumonia'were used as keywords to search related literature since January in 2014 to December in 2018.Inclusion criteria were:(1)risk factors for dysphagia with aspiration pneumonia after stroke;(2)aspiration pneumonia;(3)Kubota drinking water test.Exclusion criteria were:(1)review literature;(2)lack of research data or poor quality.The final 37 articles were included in the analysis.The literature found that the risk factors for aspiration pneumonia after dysphagia in stroke patients included indwelling of nasogastric tube,tracheotomy,bilateral brain lesions and brain stem lesions.Kubota drinking water test could play a guiding role in feeding water intake for patients with aspiration pneumonia caused by dysphagia after stroke.The use of Kubota drinking water test and dysphagia training could reduce the incidence of aspiration pneumonia.There are many risk factors for aspiration pneumonia after dysphagia after stroke.The Kubota drinking water test can guide dysphagia training and reduce the incidence of aspiration pneumonia.