周芳,马艳,孙瑞,等.间歇性经口至食管管饲对脑卒中后吞咽障碍影响的软管喉镜吞咽功能评估[J].中华物理医学与康复杂志,2025,47(10):901-905
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| 间歇性经口至食管管饲对脑卒中后吞咽障碍影响的软管喉镜吞咽功能评估 |
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| DOI：10.3760/cma.j.cn421666-20250407-00309 |
| 中文关键词: 鼻胃管管饲 间歇性经口至食管管饲 软管喉镜吞咽功能评估 鼻胃管综合征 |
| 英文关键词: Nasogastric tube feeding Oro-esophageal tube feeding Endoscopic swallowing evaluation Nasogastric tube syndrome |
| 基金项目:武汉市预防医学专项(WY22B10) |
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| 中文摘要: |
| 目的 基于软管喉镜吞咽功能评估（FEES）观察间歇性经口至食管管饲（IOE)对脑卒中后吞咽障碍（PSD）患者营养状况、并发症、吞咽功能及气道保护能力的影响。 方法 采用随机数字表法将60例PSD患者分为观察组及对照组，每组30例。2组患者均给予常规药物治疗及吞咽功能训练，观察组在此基础上给予IOE营养支持，对照组则辅以鼻胃管管饲（NGT）。于治疗前、治疗1个月后对比2组患者功能性经口摄食量表(FOIS)评分及各营养指标［包括体重指数(BMI)、血红蛋白（Hb）、血清白蛋白（ALB）、血清前白蛋白（PAB）、肱三头肌皮褶厚度（TSF）及上臂肌围（AMC）等］变化情况，并采用FEES观察2组患者咽喉部生理结构情况，包括会厌软骨形状、杓状软骨黏膜水肿程度、声带运动等，同时对2组患者咽部分泌物严重程度分级(MSS)、咽期吞咽功能-喉部感觉功能、吞咽反射能力、Yale食物残留等级(YPR-SRS)、Rosenbek渗漏/误吸等级进行评定。 结果 治疗后2组患者FOIS评分及各项营养指标（包括BMI、ALB、Hb、PAB、TSF及AMC）结果均明显改善(P<0.05)，并且上述指标均以观察组患者的改善幅度较显著（P<0.05）；治疗后2组患者在会厌形状、杓状软骨水肿、声带运动功能、咽喉感觉功能、吞咽反射功能、咽部分泌物、食物残留及渗漏误吸方面的异常人数均有不同程度减少（P<0.05），并且以观察组上述指标异常人数的减少幅度更显著（P<0.05）。 结论 与常规NGT管饲比较，IOE管饲能进一步改善PSD患者的吞咽功能，提高气道保护能力，降低鼻胃管综合征发生风险，该营养支持方式值得临床进一步推广、应用。 |
| 英文摘要: |
| Objective To compare the effects of intermittent oro-esophageal tube feeding (IOE) and nasogastric tube feeding (NGT) on nutritional status, complications, swallowing function and airway protection in persons with post-stroke dysphagia (PSD). Methods Sixty PSD patients were randomized into an observation group (n=30) and a control group (n=30). In addition to conventional medication and swallowing rehabilitation, the observation group received supplemental IOE nutrition, while the control group was given NGT. Before and after one month, both groups were evaluated using the Functional Oral Intake Scale (FOIS), and such nutritional indicators as body mass index (BMI), hemoglobin (Hb) levels, albumin (ALB), prealbumin (PAB), skinfold at the triceps (TSF) and arm muscle circumference (AMC) were measured. The morphology of each subject′s epiglottis, any edema of the arytenoid mucosa and vocal cord mobility were assessed using fiberoptic endoscopic evaluation of swallowing (FEES). Murray Secretion Scale ratings were documented, along with laryngeal sensation during swallowing, swallowing reflex, the Yale Pharyngeal Residue Severity Rating Scale, and the Rosenbek Penetration-aspiration Scale. Results Both groups showed significant improvement in their average FOIS scores and all of the nutritional descriptors, but with significantly greater improvement in the observation group. Abnormalities in the shape of the epiglottis, arytenoid edema and vocal cord mobility had decreased significantly in both groups. This was also true of larynx sensation, swallowing reflex, pharyngeal secretions, residue and penetration/aspiration. On average the improvements were significantly greater in the observation group. Conclusion Compared with NGT, IOE more effectively improves swallowing, enhances airway functioning and reduces NGT syndrome among PSD patients. These observations support its clinical adoption. |
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