多模态精准营养干预对卒中后吞咽障碍患者功能恢复的影响

陈林华; 朱美红; 沈洁; 张天慧; 郑叶平; 陈颖; 朱玮敏; 胡晨洁; 高娟梅

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陈林华,朱美红,沈洁,等.多模态精准营养干预对卒中后吞咽障碍患者功能恢复的影响[J].中华物理医学与康复杂志,2026,48(2):128-134

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多模态精准营养干预对卒中后吞咽障碍患者功能恢复的影响

DOI：10.3760/cma.j.cn421666-20250404-00300

中文关键词: 脑卒中吞咽障碍评估营养支持卒中相关性肺炎康复

英文关键词: Stroke Dysphagia Assessment Nutritional support Pneumonia Rehabilitation

基金项目:嘉兴市科学技术局公益性研究专项 (2025CGZ062)；浙江省医药卫生科技计划项目 (2024KY1688，2025KY360)；嘉兴市卫生科技计划项目 (JWKJ-25030)；教育部学位与研究生教育发展中心主题案例?健康中国 (ZT-2410354006)

作者	单位
陈林华	嘉兴市中医医院营养科,嘉兴 314000
朱美红	嘉兴大学附属第二医院康复医学科,嘉兴 314000
沈洁	嘉兴市秀洲区嘉北街道社区卫生服务中心,嘉兴 314033
张天慧	嘉兴大学附属第二医院康复医学科,嘉兴 314000
郑叶平	嘉兴大学附属第二医院康复医学科,嘉兴 314000
陈颖	嘉兴大学附属第二医院康复医学科,嘉兴 314000
朱玮敏	嘉兴大学附属第二医院康复医学科,嘉兴 314000
胡晨洁	嘉兴大学附属第二医院康复医学科,嘉兴 314000
高娟梅	嘉兴大学附属第二医院康复医学科,嘉兴 314000

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中文摘要:

目的探讨多模态精准营养干预对脑卒中后吞咽障碍患者功能恢复的影响。方法采用随机数字表法将 120 例脑卒中后吞咽障碍患者分为观察组及对照组，每组 60 例。对照组给予常规康复治疗、标准化吞咽训练及常规营养干预，观察组给予常规康复治疗、标准化吞咽训练及多模态精准营养干预。干预前、干预 4 周后，检测血清白蛋白 (ALB)、前白蛋白 (PA) 及血红蛋白 (HB) 含量，采用 Fugl-Meyer 运动功能量表 (FMA)、改良 Barthel 指数量表 (MBI)、功能性经口摄食评估量表 (FOIS) 及 Rosenbek 渗透 / 误吸量表 (PAS) 评定，对比卒中相关性肺炎 (SAP) 发生情况。结果干预后，观察组血清 ALB、PA、HB 含量及对照组 ALB 含量均较干预前明显增加（P<0.05），且观察组 ALB、PA、HB 含量及 FMA、MBI、FOIS、PAS 评分均显著优于同期对照组（P<0.05），观察组 SAP 发病率亦较对照组明显降低（P<0.05）。结论多模态精准营养干预能进一步改善卒中后吞咽障碍患者的吞咽 - 营养 - 功能转归，显著降低 SAP 发生率，值得临床推广应用。

英文摘要:

Objective To document the impact of multimodal nutritional intervention on the functional recovery of stroke survivors with dysphagia. Methods A total of 120 stroke survivors with dysphagia were randomly divided into an observation group and a control group, each of 60. In addition to conventional rehabilitation therapy and standardized swallowing training, the control group received routine nutritional intervention, while the observation group underwent multimodal precision nutritional intervention. Before and after 4 weeks, serum levels of albumin (ALB), prealbumin (PA), and hemoglobin (HB) were measured in both groups and all were assessed using the Fugl-Meyer Assessment (FMA), the Modified Barthel Index (MBI), the Functional Oral Intake Scale (FOIS), and the Rosenbek Penetration-Aspiration Scale (PAS). The incidence of stroke-associated pneumonia (SAP) was also recorded. Results Before the intervention, there were no significant differences between the two groups in their average serum ALB, PA or HB levels, nor in their average FMA, FOIS or PAS scores. After the intervention, average serum ALB, PA, and HB levels in the observation group, together with serum ALB in the control group, had increased significantly. The observation group's ALB, PA and HB levels, as well as their FMA, MBI, FOIS and PAS scores were then significantly better than the control group's averages. The incidence of SAP in the observation group was significantly lower than that in the control group. Conclusions Multimodal nutritional intervention can significantly improve swallowing, nutrition status and functional outcomes. It markedly reduces the incidence of SAP among persons with post-stroke dysphagia. It is worthy of clinical promotion and application.

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