纤维鼻咽喉镜吞咽功能检查对脑卒中吞咽障碍患者摄食训练的指导价值

The guiding value of fiber optic endoscopic examination of swallowing in feeding training of stroke patients with dysphagia

摘要:

目的 分析纤维鼻咽喉镜吞咽功能检查（FEES）对脑卒中吞咽障碍患者摄食训练的指导价值。方法 采用随机信封法将2019年1月－2021年1月北京市大兴区中西医结合医院和北京市丰台区南苑医院收治的120例脑卒中吞咽障碍患者分为观察组（n = 60）和对照组（n = 60）。对照组采用标准吞咽功能评估（SSA），在阴性后进行摄食训练，观察组采用FEES，在阴性后进行摄食训练，最终观察组纳入55例，对照组纳入54例。比较治疗前1周和治疗后1周两组患者的动脉血气分析、并发症发生情况、误吸程度、吞咽功能评级和安全性指标水平。结果 两组患者治疗后动脉血二氧化碳分压（PaCO₂）水平、误吸和腹胀发生率均较治疗前降低，且观察组较对照组低；观察组肺部感染发生率低于对照组；两组患者治疗后动脉血氧分压（PaO₂）和动脉血氧饱和度（SaO₂）水平均较治疗前升高，且观察组较对照组高；治疗后，两组患者误吸程度均较治疗前减轻，且观察组优于对照组；治疗后，两组患者吞咽功能均较治疗前改善，且观察组优于对照组，差异有统计学意义（P < 0.05）。结论 脑卒中吞咽障碍患者采用FEES，在阴性后进行摄食训练，能够有效改善动脉血气状态及吞咽功能，减轻误吸程度，降低误吸、肺炎和腹胀的发生率，安全性较高。

Abstract:

Objective To analyze the guiding value of fiber optic endoscopic examination of swallowing (FEES) in feeding training of stroke patients with dysphagia.Methods 120 stroke patients with dysphagia from January 2019 to January 2021 were randomly divided into the observation group (n = 60) and the control group (n = 60). Control group was given ingestion training after standardized swallowing function assessment (SSA) was negative. The observation group received feeding training after FEES negative. There were 55 cases in the observation group and 54 cases in the control group. Arterial blood gas analysis, complications, degree of aspiration, swallowing function rating and safety indexes were compared between the two groups 1 week before and 1 week after treatment.Results After treatment, the level of partial pressure of carbon dioxide in arterial blood (PaCO₂), the incidence of aspiration and abdominal distension in the two groups were lower than those before treatment, and the observation group was lower than that in the control group; The incidence of pulmonary infection in the observation group was lower than that in the control group; The levels of arterial partial pressure of oxygen (PaO₂) and oxygen saturation in arterial blood (SaO₂) in the two groups after treatment were higher than those before treatment, and the observation group was higher than the control group. After treatment, the degree of aspiration was reduced than that before treatment in the two groups, and the observation group was better than the control group. After treatment, the swallowing function of the observation group was better than that before treatment, and there was better in the observation group than that in the control group, and the difference was statistically significant (P < 0.05).Conclusion Feeding after FEES negative for stroke patients with dysphagia can effectively improve blood gas status and swallowing function, reduce the degree of aspiration, and reduce the incidence of aspiration, pneumonia and abdominal distension, with good safety.