邬丽娜　　姚美珍　　刘俊　　詹项英　　刘卫华

[摘要] 目的 探討间歇经口食管管饲（IOE）在促进脑卒中后吞咽功能障碍康复中的应用。 方法 选择2019年3月至2020年4月我院接收的脑卒中患者60例，随机分成观察组（n=30例）和对照组（n=30例）。对照组采用留置鼻胃管（NG）治疗，观察组采用间歇经口食管管饲（IOE）治疗。治疗后，对患者的临床效果进行评估，比较两组患者的吞咽障碍疗效、患者的满意度和治疗前后患者生活质量及营养状况各指标的变化以及并发症的发生率。 结果 治疗前，两组患者的洼田饮水试验、FOIS分级以及患者的满意度比较差异无统计学意义（P>0.05）;治疗后，观察组洼田饮水试验分级低于对照组，FOIS分级以及患者的满意度均高于对照组（P<0.05）;治疗前，两组患者生活质量SWAL-QOL评分及营养指标Hb、ALB、TP比较差异无统计学意义（P>0.05），治疗后，观察组SWAL-QOL评分、Hb、ALB、TP均高于对照组（P<0.05）;治疗后，观察组的吸入性肺炎、胃食管反流、呕吐、出血的总发生率低于对照组（P<0.05）。 结论 在促进脑卒中后吞咽功能障碍康复中使用IOE治疗患者，可以改善患者的吞咽障碍，提高患者的治疗满意度，提高患者的生活质量以及患者的营养状况，减少患者置管术后并发症发生率，保证了患者的安全，临床效果显著，值得推广使用。

[关键词] 脑卒中;吞咽功能障碍评定;留置鼻胃管（NG）;间歇经口食管管饲（IOE）

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）11-0180-04

Application of IOE in promoting rehabilitation of swallowing dysfunction after stroke

WU Li′na   YAO Meizhen   LIU Jun   ZHAN Xiangying   LIU Weihua

Department of Neurology， the Third People′s Hospital of Jingdezhen in Jiangxi Province， Jingdezhen   333000， China

[Abstract] Objective To explore the application of intermittent oro-esophageal tube feeding（IOE） in promoting the rehabilitation of swallowing dysfunction after stroke. Methods Sixty stroke patients in the hospital from March 2019 to April 2020 were selected and randomly divided into the observation group（n=30） and the control group（n=30）. The control group was treated with an indwelling nasogastric tube（NG）， and the observation group was treated with intermittent oro-esophageal tube feeding（IOE）. After treatment， the clinical effects of the patients were evaluated. The efficacy of dysphagia， the satisfaction of the patients， the changes in various indicators of the patient's quality of life and nutritional status before and after treatment， and the incidence of complications were compared between the two groups. Results Before treatment， there was no statistical difference in the watian drinking water test， FOIS classification， and patient satisfaction between the two groups of patients（P>0.05）. After treatment， the watian drinking water test classification of the observation group was lower than that of the control group， FOIS classification and the satisfaction of patients in the observation group was higher than that of the control group（P<0.05）. Before treatment， there was no significant difference in the SWAL-QOL scores and nutritional indicators Hb， ALB， TP between the two groups（P>0.05）. The SWAL-QOL score， Hb， ALB， and TP of the observation group were higher than those of the control group after the treatment（P<0.05）. After treatment， the total incidence of aspiration pneumonia， gastroesophageal reflux， vomiting， and bleeding in the observation group was lower than that of the control group（P<0.05）. Conclusion The use of IOE in the treatment of patients with swallowing dysfunction after stroke can improve patients′ dysphagia， increase patient satisfaction with treatment， improve the quality of life and nutritional status of patients， and reduce postoperative complications rate. It also ensures the safety of patients， and has a significant clinical effect， which is worthy of popularization.

[Key words] Stroke; Assessment of swallowing dysfunction; Indwelling nasogastric tube （NG）; Intermittent oro-esophageal tube feeding（IOE）

脑卒中是临床上致残率和致死率较高的脑血管循环障碍性疾病[1]，常见的并发症有肢体功能障碍、吞咽障碍等。而患者长时间由于吞咽障碍可造成营养不良、水电解质代谢紊乱、机体抵抗力下降等[2]。不良反应严重的会危害患者的生命安全。通常情况下，普遍使用经鼻胃管管饲来进行肠内营养支持。这种方法虽然解决了患者的进食问题，但是容易出现鼻黏膜损伤。误吸造成肺炎等并发症，临床效果不明显。随着医疗技术的发展，目前常使用间歇经口至食管管饲对脑卒中后的吞咽障碍患者营养支持。但是……