脑卒中吞咽障碍患者安全进食行为及影响因素研究

冯晓瑜; 黎静雯; 张咏军; 叶慧玲

doi:10.16766/j.cnki.issn.1674-4152.002876

脑卒中吞咽障碍患者安全进食行为及影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.002876

1.
广州医科大学附属第一医院全科医学科, 广东广州 510120
2.
广州医科大学附属第一医院神经内科, 广东广州 510120

基金项目:

广东省中医药局中医药科研项目 20212128

广州市卫生健康科技一般引导项目 20201A011071

详细信息

通讯作者:
叶慧玲，E-mail：dryehui66@126.com

中图分类号: R74.3
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- 文章访问数: 331
- HTML全文浏览量: 58
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- 被引次数: 0
出版历程
- 收稿日期: 2022-01-22
- 网络出版日期: 2023-04-20

Safe eating behaviour and influencing factors in patients with dysphagia after stroke

1.
Department of General Practice, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China

摘要

摘要: 目的通过分析脑卒中吞咽障碍患者安全进食行为，探讨其影响因素，为临床提供参考，重视吞咽障碍患者的进食行为。方法采用方便抽样法选取2019年1月—2020年12月在广州医科大学附属第一医院诊断为脑卒中吞咽障碍的患者为调查对象，采用一般资料调查表，包括社会人口学资料及疾病相关资料，脑卒中吞咽障碍患者安全进食行为评价量表、安全进食知识问卷收集资料并进行安全进食行为状况描述及多元逐步回归分析。结果本研究共纳入176例脑卒中吞咽障碍患者，单因素分析显示，不同文化程度、婚姻状况、是否发生过吸入性肺炎、语言障碍情况、吞咽治疗情况、Barthel指数、洼田饮水试验分级的安全进食行为比较，差异有统计学意义(均P < 0.05)；多元逐步回归分析显示，Barthel指数、安全进食知识总分、吞咽治疗情况与患者安全进食行为呈正相关关系(均P < 0.05)，语言障碍、是否发生吸入性肺炎与安全进食行为水平呈负相关关系(均P < 0.05)，5个变量的多元相关系数R=0.647，回归的R²=0.419，调整的R²=0.402。结论多种因素影响脑卒中吞咽障碍患者的安全进食行为，Barthel指数、安全进食知识总分、吞咽治疗情况、语言障碍、是否发生吸入性肺炎是独立影响因素。
- 脑卒中 /
- 吞咽障碍 /
- 进食行为 /
- 影响因素
Abstract: Objective The safe eating behaviour of patients with dysphagia after stroke was analysed to determine influencing factors and provide reference for clinical practice and pay attention to the eating behaviour of patients with dysphagia. Methods Convenience sampling was conducted to select patients with stroke and dysphagia from January 2019 to December 2020 in the First Affiliated Hospital of Guangzhou Medical University. The general information questionnaire including sociodemographic data and disease related data, stroke dysphagia patient safe eating behaviour evaluation scale and safe eating knowledge questionnaire were used to collect data and conduct safety description of eating behaviour and multiple stepwise regression analysis. Results A total of 176 stroke patients with swallowing disorders were included. Univariate analysis showed significant differences in safe eating behaviour among patients with different education levels, marital statuses, aspiration pneumonia, language disorder, swallowing treatment, Barthel Index and safe eating behaviour in Watian drinking water test (all P < 0.05). Multivariate stepwise regression analysis showed that Barthel index, total score of safe eating knowledge and swallowing treatment were positively correlated with safe eating behaviour (all P < 0.05), while language disorder and aspiration pneumonia were negatively correlated with safe eating behaviour (all P < 0.05). The multiple correlation coefficient of the five variables was r=0.647, the regression R² was 0.419 and the adjusted R² was 0.402. Conclusion A variety of factors affect the safe eating behaviour of stroke patients with dysphagia. Barthel index, total score of safe eating knowledge, swallowing treatment, language disorder and diagnosis of inhalation pneumonia are independent influencing factors.
- Stroke /
- Swallowing disorder /
- Eating behaviour /
- Influencing factors

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表 1 脑卒中吞咽障碍患者安全进食行为的社会人口学资料比较(n=176)

Table 1. Comparison of social demographic data on safe eating behavior in stroke patients with dysphagia (n=176)

项目	类别	例数(%)	行为总分(x±s，分)	统计量	P值
性别	男性	110(62.5)	75.48±16.99	-0.729^a	0.467
	女性	66(37.5)	77.48±18.67
年龄(岁)	≤55	27(15.3)	73.11±19.33	2.149^b	0.096
	> 55~65	49(27.8)	74.92±17.15
	> 65~75	48(27.4)	73.83±16.52
	> 75~86	52(29.5)	81.31±17.53
文化程度	小学及以下	66(37.5)	73.70±15.67	8.391^b	< 0.001
	初中	53(30.1)	70.47±13.94
	中专或高中	34(19.3)	81.38±21.37
	大专及以上	23(13.1)	89.17±16.84
工作情况	在职	20(11.4)	77.20±20.22	0.079^b	0.924
	退休	136(77.3)	76.27±17.30
	无业	20(11.4)	75.00±17.88
婚姻状况	已婚	150(85.2)	78.17±16.80	7.834^b	0.001
	离异/未婚	6(3.4)	55.50±12.17
	丧偶	20(11.4)	67.95±19.22
照顾者	配偶	67(38.1)	79.81±17.29	2.094^b	0.103
	儿女	72(40.9)	75.60±19.23
	护工/保姆	27(15.3)	71.41±8.85
	无陪护	10(5.7)	69.90±22.04
人均收入(元/月)	≤1 000	13(7.4)	70.31±20.94	1.406^b	0.243
	> 1 000~3 000	52(29.5)	74.69±14.82
	> 3 000~5 000	106(60.2)	77.19±18.29
	> 5 000	5(2.8)	87.40±18.91
医疗费用	完全自费	10(5.7)	71.90±20.63	0.234^b	0.873
	医保	120(68.2)	76.54±17.18
	公费	15(8.5)	77.33±17.59
	其他(商业保)	31(17.6)	75.90±18.98
注：^a为t值，^b为F值。

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表 2 脑卒中吞咽障碍患者安全进食行为疾病相关资料的比较(n=176)

Table 2. Comparison of data related to safe eating behavior in patient safety with dysphagia after stroke (n=176)

疾病变量	例数(%)	行为总分(x±s，分)	统计量	P值
卒中类型			1.142^a	0.255
脑梗死	165(93.8)	76.62±18.00
脑出血	11(6.2)	70.36±8.76
卒中受损部位			0.468^b	0.759
左侧大脑皮质	39(22.2)	75.18±16.87
右侧大脑皮质	69(39.2)	76.35±18.73
大脑皮质下	45(25.6)	78.82±20.59
脑桥	11(6.3)	78.82±20.59
延髓	12(6.8)	70.75±12.36	0.342^b	0.711
卒中时期
急性期	43(24.4)	75.35±16.21
恢复期	84(47.7)	77.38±17.99
后遗症期	49(27.8)	75.04±18.38
既往病史
高血压			-0.061^a	0.951
无	95(54.0)	76.16±16.66
有	81(46.0)	76.32±18.87
糖尿病			0.256^a	0.798
无	121(68.8)	76.46±18.20
有	55(31.2)	75.73±16.40
冠心病			1.646^a	0.102
无	146(83.0)	77.22±17.69
有	30(17.0)	71.43±16.69
语言障碍			9.515^b	< 0.001
无	90(51.1)	81.63±17.32
运动性失语	19(10.8)	71.32±19.71
构音障碍	67(38.1)	70.37±15.20
吞咽治疗			6.668^b	0.002
从未接受	63(35.8)	70.43±15.06
正在接受	13(7.4)	85.77±18.62
曾经接受	100(56.8)	78.65±18.03
Barthel指数			22.305^b	< 0.001
≤40	15(8.5)	60.87±9.21
> 40~60	15(8.5)	67.87±16.99
> 60~99	66(34.0)	68.88±13.13
> 99	80(45.5)	85.50±16.70
洼田饮水试验			7.295^b	0.001
Ⅱ级	86(48.9)	81.24±17.37
Ⅲ级	78(44.3)	71.51±17.40
Ⅳ级	12(6.8)	71.00±10.19
吸入性肺炎			3.886^a	< 0.001
否	150(85.2)	78.30±17.23
是	26(14.8)	64.31±15.14
注：^a为t值，^b为F值。

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表 3 变量赋值情况

Table 3. Variable assignment method

变量	赋值方法
文化程度	小学及以下=1，初中=2，中专/高中=3，大专及以上=4
婚姻	已婚=(0, 0)；离异/未婚=(1, 0)；丧偶=(0, 1)
是否发生吸入性肺炎	无=1，有=2
语言障碍	无=(0, 0)；运动性失语=(1, 0)；构音障碍=(0, 1)
吞咽治疗	从未接受=(0, 0)；正在接受=(1, 0)；曾经接受=(0, 1)
Barthel指数	≤40=1， > 40~60=2， > 60~99=3， > 99=4
洼田饮水试验	Ⅱ级=1，Ⅲ级=2，Ⅳ级=3
安全进食知识总分	以实际值赋值

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表 4 脑卒中吞咽障碍患者安全进食行为多元回归分析

Table 4. Multiple regression analysis of safe eating behavior in stroke patients with dysphagia

变量	B	SE	B'	t值	P值
Barthel指数	6.114	1.219	0.323	5.016	< 0.001
安全进食知识总分	0.860	0.184	0.291	4.670	< 0.001
吸入性肺炎	-10.790	2.962	-0.218	-3.642	< 0.001
吞咽治疗	3.119	1.121	0.167	2.783	0.006
语言障碍	-2.551	1.192	-0.136	-2.140	0.034

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参考文献(19)

[1]	POWERS W J, RABINSTEIN A A, ACKERSON T, et al. Correction to: 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49(3): e138. DOI: 10.1161/STR.0000000000000172.
[2]	龙露, 严谨. 老年痴呆患者进食困难的评估及护理干预进展[J]. 护理学报, 2017, 24(17): 25-29. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201717009.htm LONG L, YAN J. Assessment and nursing intervention progress of feeding difficulties in senile dementia patients[J]. Journal of Nursing \| J Nurs, 2017, 24(17): 25-29. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201717009.htm
[3]	叶燕平. 进食安全管理在脑卒中吞咽障碍所致误吸的临床护理效果探讨[J]. 吉林医学, 2017, 38(5): 994-995. doi: 10.3969/j.issn.1004-0412.2017.05.095 YE Y P. Clinical nursing effect of eating safety management in aspiration caused by dysphagia after stroke[J]. Jilin Medical Journal, 2017, 38(5): 994-995. doi: 10.3969/j.issn.1004-0412.2017.05.095
[4]	高岩, 高敏行, 姜李, 等. 脑卒中吞咽障碍患者早期进食训练监测单的设计及应用[J]. 中华护理杂志, 2018, 53(11): 1319-1322. doi: 10.3761/j.issn.0254-1769.2018.11.007 GAO Y, GAO M X, JIANG L, et al. Design of food traits eating monitoring list and its application in safety management of early feeding training in patients with dysphagia after stroke[J]. Chinese Journal of Nursing, 2018, 53(11): 1319-1322. doi: 10.3761/j.issn.0254-1769.2018.11.007
[5]	ROGER N, NATÀLIA V, PERE C, et al. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders(ESSD)[J]. Dysphagia, 2016, 31(2): 232-249. doi: 10.1007/s00455-016-9696-8
[6]	杨晨晨, 纪小凤, 马海丽, 等. 进食体位对脑卒中后吞咽障碍患者相关并发症影响的Meta分析[J]. 护士进修杂志, 2016, 31(24): 2223-2227. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201624007.htm YANG C C, JI X F, MA H L, et al. Effects of feeding position on the incidence of complications for patients with Dysphagia post-stroke: a Meta analysis[J]. Journal of Nurses Training, 2016, 31(24): 2223-2227. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201624007.htm
[7]	中华医学会全国第4届脑血管学术会议组. 各类脑血管病诊断要点[J]. 中华神经科杂志, 1996, 26(6): 376-381. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC201307036.htm The 4th National Cerebral Vascular Conference of Chinese Medical Association. Key points of diagnosis of various cerebrovascular diseases[J]. Chinese Journal of Neurology, 1996, 26(6): 376-381. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC201307036.htm
[8]	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J]. 中华物理医学与康复杂志, 2017, 39(12): 881-892. doi: 10.3760/cma.j.issn.0254-1424.2017.12.001 Expert Consensus Group on Rehabilitation Assessment and Treatment of dysphagia in China. Chinese expert consensus on the assessment and treatment of dysphagia (2017 edition) part Ⅰ evaluation[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2017, 39(12): 881-892. doi: 10.3760/cma.j.issn.0254-1424.2017.12.001
[9]	吕孟菊, 柳俊杰, 王艳冬. 首发脑卒中患者吞咽障碍居家饮食护理方案的制订及应用[J]. 中华护理杂志, 2019, 54(7): 975-981. doi: 10.3761/j.issn.0254-1769.2019.07.003 LYU M J, LIU J J, WANG Y D. Development and application of dietary nursing scheme for patients with dysphagia after first stroke[J]. Chinese Journal of Nursing, 2019, 54(7): 975-981. doi: 10.3761/j.issn.0254-1769.2019.07.003
[10]	冯晓瑜, 叶慧玲, 周玉兰, 等. 脑卒中吞咽障碍患者安全进食行为评价量表的编制及信效度检验[J]. 护理学杂志, 2020, 35(19): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202019010.htm FENG X Y, YE H L, ZHOU Y L, et al. Development and validation of a safe feeding assessment scale for stroke patients with dysphagia[J]. Journal of Nursing Science, 2020, 35(19): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202019010.htm
[11]	乔婷婷, 陈丹丹, 郑蔚, 等. 脑卒中患者自我管理知识与行为的相关性研究[J]. 现代预防医学, 2016, 43(1): 187-189, 192. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201601053.htm QIAO T T, CHEN D D, ZHENG W, et al. Correlation between the knowledge and behavior for the self-management of stroke patients[J]. Modern Preventive Medicine, 2016, 43(1): 187-189, 192. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201601053.htm
[12]	汪晖, 官小莉, 孟玲, 等. 脑卒中吞咽障碍患者护理需求及影响因素调查[J]. 护理学杂志, 2016, 31(21): 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201621010.htm WANG H, GUAN X L, MENG L, et al. Nursing care needs of stroke patients with dysphagia and the influencing factors[J]. Journal of Nursing Science, 2016, 31(21): 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201621010.htm
[13]	吴诗诗, 刘宇, 林可可, 等. 自我效能在社区2型糖尿病患者角色需求认知和自我管理间的中介效应[J]. 中华全科医学, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877 WU S S, LIU Y, LIN K K, et al. The mediating effect of diabetes self-efficacy between perceived role demands and diabetes self-management among community patients with type 2 diabetes[J]. Chinese Journal of General Practice, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877
[14]	杨静, 张建凤, 李志菊, 等. 中青年冠心病病人自我管理行为及影响因素调查[J]. 护理研究, 2013, 27(14): 1310-1312. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201314017.htm YANG J, ZHANG J F, LI Z J, et al. Survey of its and influencing factors and self-management behaviors of young and middle-aged patients with coronary heart disease[J]. Chinese Nursing Research, 2013, 27(14): 1310-1312. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201314017.htm
[15]	王兰珍, 徐利萍, 徐淑芬, 等. 循证视角下脑卒中吞咽障碍患者护理管理方案及效果评价[J]. 中华全科医学, 2021, 19(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.001848 WANG L Z, XU L P, XU S F, et al. Nursing management plan and effect evaluation of stroke patients with dysphagia from the evidence-based perspective[J]. Chinese Journal of General Practice, 2021, 19(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.001848
[16]	李玉梅, 冯为菊, 李玲, 等. 脑卒中患者吸入性肺炎危险因素分析及预防[J]. 中国继续医学教育, 2016, 8(27): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201627047.htm LI Y M, FENG W J, LI L, et al. Risk factors analysis and prevention of aspiration pneumonia in patients with stroke[J]. China Continuing Medical Education, 2016, 8(27): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201627047.htm
[17]	陈娇, 张小培, 林满秋, 等. 基于微信平台的健康促进随访模式在脑卒中合并吞咽障碍患者中的应用[J]. 中国医药导报, 2017, 14(7): 169-172. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201707043.htm CHEN J, ZHANG X P, LIN M Q, et al. Study on the application of a health promotion follow-up managementmodel based on Wechat to stroke patients with dysphagia[J]. China Medical Herald, 2017, 14(7): 169-172. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201707043.htm
[18]	张晓梅, 曹猛, 邓秋琳, 等. 经容积黏度试验介导的早期摄食训练对急性脑卒中后留置胃管病人的影响[J]. 护理研究, 2019, 33(14): 2387-2390. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201914005.htm ZHANG X M, CAO M, DENG Q L, et al. Effect of early stage ingestion exercise mediated by volume-viscosity swallow test on patients with indwelling gastric tube after acute stroke[J]. Chinese Nursing Research, 2019, 33(14): 2387-2390. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201914005.htm
[19]	LANGMORE S E, PISEGNA J M. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature[J]. Int J Speech Lang Pathol, 2015, 17(3SI): 222-229.