作者：吴小培1，禹玲2，贲国平3

单位：

1.226600 江苏省海安市人民医院神经内科　2.210029 江苏省南京市，江苏省人民医院神经内科　3.226600 江苏省海安市人民医院内科

Units：

1.Department of Neurology, Haian People's Hospital, Haian 226600, China 2.Department of Neurology, Jiangsu Province Hospital, Nanjing 210029, China 3.Department of Internal Medicine, Haian People's Hospital, Haian 226600, China

关键词：

卒中；吞咽障碍；Gugging 吞咽功能评估量表；洼田饮水试验；营养状况；生活质量

Keywords：

Stroke; Dysphagia; Gugging Swallowing Screen; Water Swallowing Test; Nutritional status; Quality of life

CLC：

R 743.7　

DOI：

10.12114/j.issn.1008-5971.2021.00.135

Funds：

南通市科技计划（指导性）项目（YYZ17032）

摘要：

背景　吞咽障碍是急性脑卒中患者常见症状之一，发生率为37%~78%，留置胃管可为其提供一定的 营养支持及维持酸碱平衡，但易引发感染、营养不良等一系列并发症。因此及时评估病情、早期安全拔管后给予经口 喂养至关重要。目的　探讨以Gugging 吞咽功能评估量表（GUSS）评分≥ 15 分作为急性脑卒中伴吞咽障碍患者拔管 指征的效果。方法　选取2019 年10 月—2020 年8 月海安市人民医院收治的急性脑卒中伴吞咽障碍并留置胃管患者 92 例，采用随机数字表法分为对照组和试验组，各46 例。剔除死亡、住院1 周内自动出院、转院患者，最终对照组 纳入38 例、试验组纳入42 例。对照组患者以洼田饮水试验Ⅰ级、Ⅱ级作为拔管指征，试验组患者以GUSS 评分≥ 15 分作为拔管指征。比较两组患者拔管后胃管复插率及吸入性肺炎、营养不良发生率。比较两组患者治疗前、出院时 营养学指标及生活质量。结果　试验组患者拔管后吸入性肺炎发生率低于对照组（P ＜ 0.05）。试验组患者出院时血 清白蛋白（Alb）、前清蛋白（PA）、转铁蛋白（TNF）水平和心理功能、躯体功能、社会功能、物质生活状态评分 及生活质量综合评定问卷（GOQLI-74）总分高于对照组（P ＜ 0.05）。结论　与洼田饮水试验Ⅰ级、Ⅱ级相比，以 GUSS 评分≥ 15 分作为拔管指征可更有效地降低急性脑卒中伴吞咽障碍患者吸入性肺炎发生率，更好地改善患者的营 养状态，进而提高其生活质量，具有一定安全性。

Abstract：

Background　Dysphagia is one of the common symptoms of acute stroke patients, with an incidence rate of 37%-78%. Nasogastric intubation can provide nutritional support and maintain acid-base balance for patients, but long-term intubation can cause infection, malnutrition and the other complications. Therefore, it is very important to evaluate the condition in time and give oral feeding after early safe nasogastric extubation. Objective　To explore the effect of taking Gugging Swallowing Screen (GUSS) score ≥ 15 as indication of extubation in patients with acute stroke complicated with dysphagia. Methods　A total of 92 patients with acute stroke complicated with dysphagia and indwelling gastric tube admitted to Haian People's Hospital from October 2019 to August 2020 were selected, and they were divided into the control group and the experimental group by random number table method, with 46 cases in each group. Excluding patients who died, automatically discharged within 1 week of hospitalization, and transferred to hospital, the control group finally included 38 patients and the experimental group included 42 patients. Patients in the control group used Water Swallowing Test Ⅰ , Ⅱ grade as indication for extubation, and patients in the experimental group used the GUSS score ≥ 15 as indication for extubation. Gastric tube reattachment rate and incidence of inhalation pneumonia, malnutrition after pulling out the tube, nutritional indicators and quality of life before pulling out the tube and after discharge were compared. Results　The incidence of inhalation pneumonia in the experimental group was lower than that in the control group (P < 0.05) . Levels of serum albumin (Alb) , prealbumin (PA) , transferrin (TNF) and scores of mental function, physical function, social function, material life status and total score of GOQLI-74 in the experimental group were higher than those in the control group (P < 0.05) . Conclusion　Compared with Water Swallowing Test Ⅰ , Ⅱ grade, taking GUSS score ≥ 15 as indication for extubation can effectively reduce incidence of inhalation pneumonia of patients with acute stroke complicated with dysphagia, improve nutritional status, and promote quality of life, and with high safety.

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