DYSPHAGIA THERAPY FOLLOWING STROKE - A CONTROLLED TRIAL
DYSPHAGIA THERAPY FOLLOWING STROKE - A CONTROLLED TRIAL
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DOI：
10.1212/wnl.44.9.1655
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发表时间：
1994-09-01
期刊：
影响因子：
9.9
通讯作者：
LESSER, ML
中科院分区：
文献类型：
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作者：
DEPIPPO, KL;HOLAS, MA;LESSER, ML
目的：确定吞咽困难治疗师分级干预对肺炎、脱水、热量氮缺乏、复发性上气道阻塞和卒中后死亡发生的影响。设计：随机对照试验，地点：住院中风康复中心。患者：所有患者均符合以下合格性标准：（1）通过临床病史和兼容CT或MRI的神经学检查定义的卒中，（2）年龄20至90岁（含），（3）无已知的显著口腔或咽部异常病史，（4）实验室值低于终点标准，（5）Burke吞咽困难筛查试验失败，和（6）改良的吞咽钡剂评估吞咽困难的证据（排除了即使使用补偿性吞咽技术，但吸入大于或等于50%的所有吞咽困难的患者）。在123名符合条件的患者中，8名拒绝参加研究。115例患者接受了随机化。干预措施：在住院康复期间，提供了三个等级的吞咽困难治疗师控制饮食一致性和加强补偿性吞咽技术。主要观察指标：肺炎、脱水、热量氮缺乏、复发性上呼吸道阻塞和死亡。结果如下：对数秩统计显示，三个治疗组之间在住院期间或中风后1年至终点的时间分布没有显着差异。结论：在住院康复期间，对患者和家庭进行关于饮食调整和补偿性吞咽技术的有限指导与治疗师控制饮食一致性和每日练习补偿性吞咽技术一样有效，可预防卒中后吞咽困难相关的医学并发症。
Objective: To determine the effect, of graded levels of intervention by a dysphagia therapist on the occurrence of pneumonia, dehydration, calorie-nitrogen deficit, recurrent upper airway obstruction, and death following stroke. Design: A randomized control trial, Setting: Inpatient stroke rehabilitation unit. Patients: All patients met the following eligibility criteria: (1) stroke defined by clinical history and neurologic examination with compatible CT or MRI, (2) ages 20 to 90 years inclusive, (3) no known history of significant oral or pharyngeal anomaly, (4) laboratory values below end point criteria, (5) failure on the Burke Dysphagia Screening Test, and (6) modified barium swallow evaluation evidence of dysphagia (patients who aspirated greater than or equal to 50% of all consistencies presented, even using compensatory swallowing techniques, were excluded). Of 123 eligible patients, eight refused study participation. One hundred fifteen patients were randomized. Interventions: Three graded levels of dysphagia therapist control of diet consistency and reinforcement of compensatory swallowing techniques were provided during the inpatient rehabilitation stay. Main outcome measures: Pneumonia, dehydration, calorie-nitrogen deficit, recurrent upper airway obstruction, and death. Results: The log rank statistic showed no significant difference between the three treatment groups for the distribution of time until end point during the inpatient stay or to 1 year post-stroke. Conclusion: Limited patient and family instruction regarding use of diet modification and compensatory swallowing techniques during inpatient rehabilitation is as effective as therapist control of diet consistency and daily rehearsal of compensatory swallowing techniques for the prevention of medical complications associated with dysphagia following stroke.