经鼻留置胃管与间歇性经口至食管管饲法应用于脑卒中后吞咽障碍患者的临床评价

关键词：经鼻留置胃管管饲  间歇性经口至食管管饲法  软管喉镜吞咽功能评估  鼻胃管综合征

Keywords:nasal indwelling gastric tube feeding  intermittent oro-esophageal tube feeding  flexible endoscopic evaluation of swallowing  nasogastric tube syndrome

摘要：

      摘要 目的：基于软管喉镜吞咽功能评估（flexible endoscopic evaluation of swallowing， FEES），比较经鼻留置胃管管饲（nasal indwelling gastric tube feeding， NGT）与间歇性经口至食管管饲法（Intermittent oro-esophageal tube feeding， IOE）在减少鼻胃管综合征发生率、改善咽期吞咽功能和气道保护功能方面是否存在疗效差异。 方法：选取脑卒中后吞咽障碍患者54例，根据营养摄入方式分为NGT组28例，IOE组26例。其中NGT组中有14例患者由NGT转变为IOE，将这些患者归为NGT-IOE亚组，另外14例继续沿用NGT，为NGT-NGT亚组。采用FEES评定各组患者的咽喉部生理结构情况，包括会厌形状、杓状软骨黏膜水肿程度、声带运动能力；咽喉部分泌物情况，包括分泌物严重程度分级（Murry secretion severity scale， MSS）；咽期吞咽功能-喉部感觉功能、吞咽反射能力、食物残留等级（Yale pharyngeal residue severity rating scale， YPR-SRS）、Rosenbek渗漏/误吸等级（penetration-aspiration scale， PAS），并使用吞咽功能性交流测试评分（functional communication measure swallowing， FCM）评定患者整体的吞咽能力。 结果：NGT组与IOE组患者的各项评分比较，NGT组患者的MSS、PAS、FCM评分显著低于IOE组（P<0.05），且会厌形状异常和杓状软骨黏膜水肿程度显著高于IOE组（P<0.05）。NGT-IOE亚组患者拔管后MSS、YPR-SRS（会厌谷）、YPR-SRS（梨状窝）、PAS、FCM评分较拔管前显著提高（P<0.05），提示存在鼻胃管综合征的会厌形状异常情况、杓状软骨黏膜水肿和声带外展受限均较拔管前显著降低（P<0.05），另外，喉部感觉功能也较拔管前显著改善（P<0.05）。NGT-NGT亚组两周前、后的各项评分比较均无显著性意义（P>0.05）。 结论：与NGT相比，IOE可以减少脑卒中后吞咽障碍患者鼻胃管综合征的发生率，并改善咽期吞咽和气道保护功能，故对于长期留置鼻饲胃管的患者，有必要尽早考虑转变为IOE的可能性。

Abstract:

      Abstract Objective： Comparing the efficacy of NGT and IOE in reducing the incidence of nasogastric tube syndrome （NGTS）， improving swallowing function and airway protection function in pharyngeal stage by FEES. Method： Totally 54 dysphagia patients after stroke were divided into NGT group （n=28） and IOE group （n=26） according to their methods of nutritional intake. Among them， 14 patients in the NGT group who changed from NGT to IOE were classified as NGT-IOE subgroup， and the other 14 patients who continued to use NGT were classified as NGT-NGT subgroup. FEES was used to evaluate the laryngopharynx structure including the epiglottis shape， the edema degree of arytenoid cartilage and vocal cord movement； pharyngeal secretions including Murry secretion severity scale（MSS）； pharyngeal swallowing function including laryngeal sensory function， swallowing reflex， YPR-SRS （Yale pharyngeal residue severity rating scale） and PAS （penetration-aspiration scale）. Further， FCM （functional communication measure swallowing） was used to assess the communication and swallowing abilities of patients. Result： The scores of MSS， PAS and FCM in the NGT group were significantly lower than those in the IOE group （P<0.05）， and the degree of arytenoid cartilage edema and abnormal shape of epiglottis in the NGT group were significantly higher than those in the IOE group （P<0.05）. The scores of MSS， YPR-SRS （epiglottic vallecula）， YPR-SRS （piriform sinus）， PAS and FCM in the NGT-IOE subgroup significantly increased after changing to IOE （P<0.05）. The limitation of vocal cord abduction， arytenoid cartilage edema and abnormal shapes of epiglottis that suggested NGTS were significantly improved （P<0.05）. In addition, the laryngeal sensory function was significantly improved （P<0.05）. However， for these measures， there was no significant difference between before and after two weeks in NGT-NGT subgroup （P>0.05）. Conclusion： Compared with NGT， IOE reduces the incidence of NGTS in post-stroke patients with dysphagia and improves the functions of pharyngeal swallowing and airway protection.