电子鼻咽喉镜联合改良容积黏度吞咽测试在脑梗死伴吞咽障碍患者康复中的应用

Application of video nasopharyngoscopy combined with modified Volume-Viscosity Swallow Test in the rehabilitation of patients with cerebral infarction and dysphagia

摘要:

目的 分析电子鼻咽喉镜联合改良容积黏度吞咽测试（VVST-CV）在脑梗死伴吞咽障碍患者康复中的应用。方法 选取2022年6月—2024年6月温州市中心医院神经内科收治的62例脑梗死伴吞咽障碍患者为研究对象，按照简单随机方法分为对照组（常规进食方案）和研究组（基于电子鼻咽喉镜联合VVST-CV测试的进食方案），每组31例。干预3周后统计两组的康复疗效及留置胃管率、肺部感染率、拔管时间> 14 d的占比，并记录康复治疗前后吞咽功能［标准吞咽量表（SSA）评分、功能性经口摄食量表（FOIS）分级、渗透-误吸量表（PAS）分级、Murry分泌物严重程度（MSS）分级］及血清指标［白蛋白（ALB）、血红蛋白（Hb）、C反应蛋白（CRP）］水平。结果 研究组总有效率高于对照组（P <0.05），肺部感染率及拔管时间>14 d的占比低于对照组（P <0.05）。对照组和研究组留置胃管率比较，差异无统计学意义（P >0.05）。研究组治疗前后SSA评分、FOIS分级、PAS分级、MSS分级及Hb、CRP水平的差值均大于对照组（P <0.05）。对照组与研究组治疗前后ALB水平的差值比较，差异无统计学意义（P>0.05）。结论 电子鼻咽喉镜联合VVST-CV测试可提高脑梗死伴吞咽障碍患者的康复效果，降低肺部感染风险，缩短拔管时间，改善吞咽功能，且不会显著降低血清Hb水平。

关键词:脑梗死;吞咽障碍;电子鼻咽喉镜;改良容积黏度吞咽测试;康复

Abstract:

Objective To analyze the application of video nasopharyngoscopy combined with the Chinese Version of modified Volume-Viscosity Swallow Test (VVST-CV) in the rehabilitation of patients with cerebral infarction and dysphagia.Methods The 62 patients with cerebral infarction complicated by dysphagia admitted to the Department of Neurology of Wenzhou Central Hospital during June 2022 to June 2024 were selected. They were randomly assigned to the control group (conventional feeding plan) and the study group (feeding plan based on video nasopharyngoscopy combined with VVST-CV results), with 31 cases in each group. After 3 weeks of intervention, the rehabilitation outcome, gastric tube retention rate, pulmonary infection rate and proportion of patients with extubation time > 14 days in the two groups were analyzed. The swallowing function [Standardized Swallowing Assessment (SSA) scores, Functional Oral Intake Scale (FOIS) levels, Penetration-Aspiration Scale (PAS) scores, Murray Secretion Scale (MSS) levels] and levels of serum indicators [albumin (ALB), hemoglobin (Hb), C-reactive protein (CRP) ] were recorded before and after rehabilitation treatment.Results The overall effective rate in the study group was higher than that in the control group (P < 0.05), while the pulmonary infection rate and proportion of patients with extubation time > 14 days in the study group were lower than those in the control group (P < 0.05). There was no significant difference in the gastric tube retention rate between the two groups (P > 0.05). The differences in SSA scores and levels of FOIS, PAS, and MSS as well as the Hb and CRP levels before and after treatment in the study group were greater than those in the control group (P < 0.05). The difference in the ALB level before and after treatment was not different between the two groups (P > 0.05).Conclusions Video nasopharyngoscopy combined with VVST-CV can improve the rehabilitation outcomes of cerebral infarction patients with dysphagia, reduce the risk of pulmonary infection, shorten the time to extubation, and enhance the swallowing function, without significantly reducing the serum Hb level.

Key words:cerebral infarction;dysphagia;video nasopharyngoscopy;modified Volume-Viscosity Swallow Test;rehabilitation