摘要
目的:探讨可影响脑卒中后摄食-吞咽障碍患者预后的相关因素,为临床上摄食-吞咽障碍患者是否做进一步的康复训练、静脉营养、鼻饲、胃造瘘或环咽肌扩张术治疗等处理提供依据。方法:由言语治疗师、作业治疗师和康复医师共同合作,对卒中单元每位患者进食前都进行摄食-吞咽困难的筛选,如确定有吞咽困难,选择其中意识清晰、病情稳定、能够遵循简单指令者,对其进行简易精神状态检查(MMSE)、咽反射、舌运动、声音改变、自主咳嗽、中枢性面瘫等检查。共588例脑卒中患者入选本研究。由作业治疗师对有认知功能障碍患者进行作业治疗,言语治疗师给予摄食-吞咽功能的康复训练,出院时再次进行吞咽能力评估。以摄食-吞咽障碍患者是否存在认知障碍、舌偏瘫、舌上举困难、单侧或双侧面瘫、自主咳嗽减弱、咽反射迟钝或消失及进食后声音改变等临床表现为观察指标,探讨诸多因素对该类患者预后的影响。结果:多因素Logistic回归分析发现,认知障碍(X1)、舌偏瘫(X2)、舌上举困难(X3)、双侧面瘫(X5)、自主咳嗽减弱(X6)、咽反射消失(X8)及进食后声音改变(X9)均为摄食-吞咽障碍患者预后不良(吞咽困难未愈=1)的影响因素(P<0.05)。结论:对脑卒中急性期患者的详细查体及评定,可以协助判断摄食-吞咽障碍的预后,且为临床治疗摄食-吞咽障碍提供科学依据。
Objective： To study the prognostic factors of post-stroke patients with feeding-swallowing disorders and to provide clinical basis for further treatment such as rehabilitation,intravenous nutrition,nasal feeding,gastrostomy or expansion of pharyngeal muscle and so on. Method： Speech therapists,occupational therapists and rehabilitation physicians worked together for patients with feeding-swallowing disorders in stroke unit before eating, to choose the patients with dysphagia as well as clear awareness, stable condition and being able to follow simple commands,and then to inspect them about mini-mental status examination（MMSE）, pharyngeal reflex,tongue movement,change of voice,self-cough and central facial paralysis. A total of 118 stroke patients were enrolled in this study. The patients with cognitive impairment were treated by occupational therapist,while rehabilitation of feeding-swallowing function were operated by speech therapists. Feeding-swallowing function were re-assessed when the patients discharged from hospital. Finally,the evaluation of clinical factors and influence on prognosis of the patients with dysphagia were analysed by observing cognitive impairment,tongue hemiplegia, difficulty in raising the tongue,one or two side facial paralysis,weakening in self-cough, weakening or disappearing of pharyngeal reflex as well as the changes of voice after eating. Result：With Logistic regression analysis of multi-factors it was found that cognitive impairment（X1）,tongue hemiplegia （X2）, difficulty in raising the tongue （X3）,two-side facial paralysis （X5）,weakening in self-cough （X）,disappearing ofpharyngeal reflex （X8） and the changes of voice after eating （X9） were impact factors for the poor prognosis in patients with dysphagia（P0.05）. Conclusion： A detailed physical inspection and evaluation of patients in acute phase of stroke were helpful for determining the prognosis of dysphagia,and could provide a scientific basis for the clinical treatment of dysphagia.
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2010年第4期322-325,共4页
Chinese Journal of Rehabilitation Medicine
