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目的:通过分析说话瓣膜对气管切开吞咽障碍患者渗漏、误吸的影响,探讨说话瓣膜对吞咽障碍的治疗价值。方法:32例气管切开后长期未能拔除气管套管伴吞咽障碍的患者,在其气管套管口佩戴说话瓣膜,佩戴1周后,采用吞咽造影检查观察未佩戴与佩戴说话瓣膜时渗漏、误吸程度的变化,比较其渗漏和误吸的发生率,应用Rosenbek误吸程度分级量表对其进行评价。结果:吞咽造影检查发现32例气管切开患者在未佩戴与佩戴说话瓣膜时误吸的发生率分别为81.25%和56.25%,Rosenbek分级全部为异常级别,未佩戴与佩戴说话瓣膜比较,26例级别有变化,6例级别无变化。结论:气管切开患者佩戴说话瓣膜能显著降低误吸的程度和发生率。 相似文献
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目的:探讨不同稠度和容积吞咽任务对卒中后吞咽障碍患者吞咽生理成分表现及渗漏误吸的影响。方法:选取在我院康复科治疗的59例脑卒中后吞咽障碍患者作为研究对象,参照中国改良容积粘度测试程序,按2、1、0、3号(分别对应中稠度、低稠度、硫酸钡原液及高稠度)顺序分别对每种稠度食物进行3、5、10 ml的吞咽造影检查。使用标准化吞... 相似文献
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目的 对脑卒中吞咽障碍患者食管清除功能异常的发生率及严重程度进行回顾性分析,探讨脑卒中后食管清除功能异常患者的临床特点,并分析食管清除功能异常与口咽期吞咽生理及渗漏误吸间的相关性。 方法 选取2019年10月至2023年4月期间在我院康复科住院、并完成吞咽造影检查(含正位像食管清除观察)的174例脑卒中患者作为研究对象,从其医疗记录中收集临床资料数据,并针对患者吞咽5 ml高稠度食物的正位像及侧位像造影结果进行分析。采用改良钡剂吞咽障碍造影评估量表(MBSImP)的食管清除(EC)项目对患者的食管清除功能进行评级,并对其口腔期及咽期的各吞咽生理成分进行评分。采用Rosenbek渗漏误吸量表对患者进食的安全性进行评级。 结果 在174例入选患者中,共发现70例(40.23%)患者有食管清除功能异常,且大部分(共43例)患者表现为食管中到远端滞留。与食管清除正常组患者比较,食管清除异常组患者的平均年龄更高、咽期总体障碍程度更严重(P<0.001)。通过相关性分析发现,入选患者食管清除功能与口腔期范畴的各吞咽生理成分及渗漏误吸评级均无显著相关性(P>0.05),而与咽期范畴的喉上抬(r=0.229,P=0.002)、舌骨前移运动(r=0.244,P=0.001)、咽蠕动(r=0.521,P<0.001)、咽收缩(r=0.309,P<0.001)、食管上括约肌开放(r=0.337,P<0.001)、舌根收缩(r=0.261,P=0.001)及咽部残留(r=0.260,P=0.001)均具有显著正相关性。 结论 脑卒中吞咽障碍患者可同时合并食管清除功能障碍。食管清除功能异常与年龄及咽期吞咽障碍严重程度相关。咽期吞咽生理异常可能伴随更高的食管清除异常发生率,咽蠕动减弱常提示伴随更严重的食管清除异常。将正位像食管清除观察纳入常规吞咽造影检查中,有助于筛查食管功能异常以早期识别临床问题,提高吞咽评估的全面性及系统性。 相似文献
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目的:探讨喂食技巧对脑卒中吞咽障碍患者误吸的影响.方法:将60例脑卒中吞咽障碍患者随机分为治疗组和对照组各30例,对照组给予常规药物、运动、理疗、针灸、吞咽训练等治疗及常规喂食,治疗组在此基础上根据患者病情采取喂食技巧,比较两组误吸发生率.结果:治疗组患者误吸发生率低于对照组(P<0.05).结论:喂食技巧可有效降低脑卒中吞咽障碍患者误吸发生率. 相似文献
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目的探讨糊状食物对脑卒中吞咽障碍患者误吸的影响。方法选择2013年2月~2014年2月在我科收治的脑卒中吞咽障碍患者不能通过吞水测试、而吞糊测试通过的患者40例,将患者随机分为实验组和对照组,每组20例,实验组患者在入院后采取喂食糊状食物,对照组患者在入院后按常规留置胃管鼻饲流质。结果实验组患者无一例发生误吸,而对照组有4例发生误吸,两组差异有统计学意义(P0.05)。结论糊状食物对不能通过吞水测试、而通过吞糊测试的脑卒中吞咽障碍患者能有效减少误吸、促进吞咽功能恢复,增加进食乐趣。 相似文献
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目的 观察食物性状改良对脑卒中后吞咽障碍患者误吸的影响。 方法 选取2018年1月至2018年12月期间在我科住院治疗的脑卒中伴吞咽障碍患者60例,采用随机数字表法将其分为观察组及对照组。2组患者均给予常规吞咽训练,对照组在研究期间摄入常规性状食物,观察组患者则采用饮食调整策略对其食物性状进行改良。于治疗前、治疗6周后对比2组患者误吸人数、食物剩余量、继发肺部感染以及吞咽功能改善情况。 结果 治疗6周后发现观察组患者误吸人数(5例)、食物剩余量[(4.6±3.3)ml]、继发肺部感染人数(2例)及吞咽功能[功能性吞咽困难量表(FDS)评分为(35.2±2.9)分]改善情况均显著优于对照组水平(P<0.05)。 结论 通过对食物性状进行改良有利于降低脑卒中吞咽障碍患者误吸风险,改善吞咽功能,该干预策略值得在脑卒中吞咽障碍患者中推广、应用。 相似文献
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G. Paris O. Martinaud D. Hannequin A. Petit A. Cuvelier E. Guedon P. Ropenneck E. Verin 《Annals of physical and rehabilitation medicine》2012,55(9-10):601-608
ObjectiveIt is a major issue to diagnose and detect oropharyngeal dysphagia in the early stage of ALS in order to avoid pulmonary and nutritional complications. The aim of this study was to validate a simple clinical test, the Volume-Viscosity Swallow Test (V-VST), to detect oropharyngeal dysphagia in this population.Patients and methodsTwenty patients were included in this study (mean age: 66.1 ± 8.13, six women). All patients had their swallowing function assessed by videofluoroscopy and V-VST.ResultsAmong these 20 patients, 15 presented oropharyngeal dysphagia, diagnosed by videofluoroscopy, and five had normal swallowing. Norris score was lower in patients with oropharyngeal dysphagia compared to the patients with normal swallowing (27 ± 6 versus 36 ± 2; P = 0.003). Among the 15 patients with oropharyngeal dysphagia, 14 had abnormal V-VST, and only one had normal V-VST. The sensibility of V-VST to detect oropharyngeal dysphagia in these patients with ALS was of 93%, and the specificity was of 80% (P = 0.007). There was no significant difference between the two populations for ALSFRS score (22 ± 6 versus 20 ± 6) and body mass index (BMI) (26 ± 6 versus 26 ± 6 kg/m2).ConclusionThe V-VST presented good sensibility and specificity. It may be interesting to use it systematically for the detection of oropharyngeal dysphagia in ALS, after confirming these results on a wider patient sample. 相似文献
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目的比较聚氨酯鼻饲管与硅胶鼻饲管在脑卒中吞咽功能障碍患者鼻饲中一次置管成功率及舒适度情况。方法将80例吞咽功能障碍患者随机分为实验组42例与对照组38例,实验组患者给予聚氨酯鼻饲管插管鼻饲,对照组患者给予硅胶鼻饲管插管鼻饲。比较两组患者一次置管成功率、置管时间及舒适度。结果实验组患者一次置管成功率为90.5%,对照组为60.5%,两组比较,P<0.01,差异具有统计学意义;实验组患者置管所需时间为(12.2±2.3)min,对照组为(15.6±2.5)min,两组比较,P<0.01,差异具有统计学意义;实验组患者插管舒适度明显优于对照组,两组比较,P<0.01,差异具有统计学意义。结论聚氨酯鼻饲管较硅胶鼻饲管更适用于脑卒中吞咽功能障碍患者,其置管一次成功率高、置管时间短、患者耐受性好,值得临床推广应用。 相似文献
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目的 探讨家庭参与式口咽操训练在卒中后吞咽困难患者的吞咽功能康复及营养状态改善中的应用及效果评价。方法 选取经洼田饮水试验评估为吞咽困难的脑卒中患者160例,按照随机数字法分为试验组与对照组,每组80例。对照组患者给予常规的吞咽功能训练,试验组给予常规的吞咽功能训练和家庭参与式口咽操训练。2组患者接受30d干预后,对其吞咽功能、吸入性肺炎发生率及营养状态进行评定与分析。结果 干预后,试验组吞咽困难改善情况好于对照组,差异具有统计学意义(P<0.05);干预期间试验组吸入性肺炎发生率为11.25%,明显低于对照组(31.25%),差异具有统计学意义(P<0.05);干预后,试验组营养风险评分为(2.74±0.69),明显低于对照组[(3.04±1.02)],差异具有统计学意义(P<0.05)。结论 针对吞咽功能障碍的卒中患者,在常规吞咽功能训练的基础上加用家庭参与式口咽操可有效改善患者吞咽功能,降低吸入性肺炎的发生率,改善营养状态。 相似文献
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Huang JY Zhang DY Yao Y Xia QX Fan QQ 《The Journal of international medical research》2006,34(3):303-306
This study investigated the frequency of aspiration pneumonia in conscious stroke patients fed by a family member and examined the effect of introducing training in swallowing techniques by nurses. A total of 96 consecutive patients presenting with dysphagia due to acute stroke were included in the study. Patients presenting between January 2000 and July 2003 (n = 48) were fed orally by a family member given general nursing information (group A), whereas those presenting between August 2003 and March 2005 (n = 48) were fed orally by an experienced nurse trained in specific swallowing techniques (group B). All patients were examined daily for the presence of aspiration pneumonia. The incidence of aspiration pneumonia was 33.3% in group A and 6.3% in group B (P < 0.05). The incidence of aspiration pneumonia in dysphagic stroke patients who are orally fed is still high. Training in swallowing during oral feeding offers clear protection against pneumonia in conscious stroke patients. 相似文献
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Preventing aspiration in older adults with dysphagia 总被引:1,自引:0,他引:1
Dysphagia, the impairment of any part of the swallowing process, increases the risk of aspiration. Dysphagia and aspiration are associated with the development of aspiration pneumonia. While some changes in swallowing may be a natural result of aging, dysphagia is especially prevalent among older adults with neurologic impairment or dementia, leading to an increased risk of aspiration and aspiration pneumonia. This article discusses best practices for assessment and prevention of aspiration among older adults who are being hand-fed or fed by tube. To view an accompanying online video, go to http://links.lww.com/A226. 相似文献
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目的 探讨经皮内镜下胃造口术(PEG)预防吞咽障碍患者吸入性肺炎的疗效。 方法 回顾性分析我科收治的43例行PEG术患者临床资料,通过分析患者临床表现、实验室检查及影像学检查结果,对PEG前、后患者吸入性肺炎发生率、痰液微生物检查结果和抗生素使用情况进行比较。 结果 与PEG术前相比,PEG术后患者吸入性肺炎发生率降低(临床诊断发生率:90.7% vs 53.5%,P<0.05;影像诊断发生率:70.4% vs 18.5%,P<0.05),β内酰胺酶抑制剂复方制剂的使用较术前下降(37.2% vs 62.8%,P<0.05);PEG术后痰标本铜绿假单孢菌的检出率较术前增加(72.7% vs 31.8%,P<0.05)。 结论 PEG术可减少吞咽障碍患者吸入性肺炎的发生及广谱抗生素的使用,可能增加下呼吸道铜绿假单孢菌的定植。 相似文献
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Individuals with advanced oropharyngeal cancer often experience dysphagia as a result of their illness and its treatment. Research consistently demonstrates that dysphagia and difficulty with oral intake have many implications, including a negative impact on quality of life. Nurses are in a key position to provide support and initiate appropriate interventions for individuals with dysphagia. Using the Human Response to Illness model (Mitchell et al, 1991) as an organising framework, this paper presents a critical review of the empirical literature regarding dysphagia in individuals with advanced oropharyngeal cancer that will: i) provide the reader with a comprehensive understanding of dysphagia; ii) identify current gaps in our knowledge; and iii) establish the foundation for appropriate evidence-based interventions to optimise functioning and quality of life in this patient population. 相似文献