摘要
目的:观察急性单侧大脑半球脑梗死出现吞咽障碍患者实行早期干预性措施对吞咽功能全身营养状况的影响。方法:选择2002-02/2003-08江门市人民医院收治的急性单侧大脑半球脑梗死并采用饮水试验评定为Ⅲ级以上的患者61例,随机分成两组,实验组31例和对照组30例,均采用常规内科药物治疗,实验组同时实行吞咽困难早期干预性治疗措施,包括调整食物形态,调整摄食姿势,调整进餐次数,鼻饲管喂食,咽拭子训练及电针治疗。对照组常规进餐。两组患者在治疗前及治疗14d后进行以下列指标评定。①采用饮水试验法评定吞咽功能,Ⅰ级为优,Ⅴ级为障碍。②根据营养指标评定营养不良程度,分轻、中、重。③拍X射线片观察吸入性肺炎发生情况。结果:按意向处理分析,61例进入结果分析。①吞咽功能:实验组患者治疗前Ⅳ级11例,Ⅴ级20例,治疗后Ⅰ级29例,Ⅱ级2例;对照组治疗前Ⅳ级10例,Ⅴ级20例,治疗后Ⅰ级5例,Ⅱ级19例,Ⅲ级3例,Ⅳ2例,Ⅴ1例,实验组吞咽功能恢复较对照组理想(P<0.01)。②营养状况:入院第1天治疗前实验组营养不良轻度3例,治疗14d后,轻度5例,中度1例;对照组入院第1天轻度2例,入院14d后,轻度10例,中度8例,重度12例,治疗后实验组重度营养不良患者明显低于对照组(P<0.01)。③吸入性肺炎发生情况:实验组患者发生例数(0)
AIM:To observe the effect of early intervention for impaired swallowing and nutritional status of total body in patients with acute cerebral infarction in unilateral cerebral hemisphere.METHODS:A total of 61 patients with more than grade Ⅲ cerebral infarction in unilateral cerebral hemisphere were evaluated by water drinking test in the Jiangmen People's Hospital from February 2002 to August 2003,and then were divided randomly into two groups:experimental group(n=31) and control group(n=30).Rats all received routine drug treatment;meanwhile,experimental group received early intervention,including the adjustment of food shape,ingestive posture and eating times,feeding through nasal feeding tub,throat swab training and electro acupuncture treatment.Rats in control group received routine diet.The following indexes were detected before and at day 14 after treatment:① the swallowing function was evaluated by using water drinking test,gradeⅠ was excellent and grade Ⅴ was disturbance;② the dystrophy was classified into middle,moderate and severe levels evaluated with nutritional marker;③ the occurrence of aspiration pneumonia was detected by using X ray.RESULTS:According to intention to treat,all 61 patients were involved in the result analysis.① Swallowing function:grade Ⅳ occurred in 11 cases,grade Ⅴ occurred in 20 cases before treatment in experimental group,gradeⅠ indicated in 29 cases,grade Ⅱ in 2 cases after treatment;grade Ⅳ in 10 cases,grade Ⅴ in 20 cases before treatment in control group,gradeⅠ in 5 cases,grade Ⅱ in 19 cases,grade Ⅲ in 3 cases,grade Ⅳ in 2 cases,and grade Ⅴ in 1 case after treatment.The recovery of swallowing function was superior in experimental group as compared with control group(P< 0.01).② Nutritional status: on the first day when hospitalization,mild dystrophy occurred in 3 cases,after 14 day treatment,mild in 5 cases,moderate in 1 case in experimental group;on the first day when hospitalization,mild in 2 case,after 14 day treatment,mild in 10 cases,moderate in 8 cases,severe in 12 cases in control group.The number of patients with severe dystrophy in experimental group decreased obviously as compared with control group(P< 0.01).③ The occurrence of aspiration pneumonia in experimental group(0 case) decreased obviously as compared with that in control group(8 cases)(PCONCLUSION:Early intervention can significantly improve the swallowing function and nutritional status of total body,decrease the occurrence of aspiration pneumonia in patients with impaired swallowing due to unilateral acute cerebral infarction.It can provide good conditions for the rehabilitation of neurologic impairment.
出处
《中国临床康复》
CSCD
北大核心
2005年第17期6-7,共2页
Chinese Journal of Clinical Rehabilitation
