Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial
Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial
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DOI：
10.1016/s1474-4422(05)70252-0
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发表时间：
2006-01-01
期刊：
影响因子：
48
通讯作者：
Pizzi, J
中科院分区：
文献类型：
--
作者：
Carnaby, G;Hankey, G;Pizzi, J
背景：中风后出现吞咽功能障碍是很常见的，但是关于如何控制吞咽功能障碍的可靠证据很少。这项研究比较了标准的低强度和高强度行为干预与吞咽困难的常规护理。方法306例急性脑卒中合并临床吞咽困难患者随机分为两组，由主治医师处方常规护理102例；标准低强度干预（n=102），包括吞咽补偿策略和饮食处方，每周三次，持续最多一个月；或标准的高强度干预和饮食处方（n=102），每天至少持续一个月。主要结局指标是6个月无异常饮食的生存。分析是通过意向治疗完成的。本研究已在ClinicalTrials.gov注册，编号NCT00257764。结果60例患者死亡，3例患者失访。在随机分配常规治疗的患者中，56%（57/102）在没有异常饮食的情况下存活6个月，而分配标准吞咽治疗的患者为67%(136/204)（相对风险1.9,95% CI 0.98-1.45）。标准吞咽治疗与死亡率（0.80,0.5-1.3）、住院率（0.69,0.4-1.1）和依赖性（1.05,0.8-1.3）降低相关，但趋势不显著；显著减少与吞咽相关的医疗并发症（0.73,0.6-0.9）、胸部感染（0.56,0.4-0.8）和死亡或住院（0.73,0.55-0.97）；术后6个月患者恢复吞咽功能的比例明显上升（1.41,1.03-1.94）。与常规护理和低强度治疗相比，高强度治疗与6个月后恢复正常饮食（p=0.04）和恢复吞咽（p=0.02）的患者比例增加相关。这些数据表明，在吞咽困难的中风患者中，给予标准的早期行为吞咽干预方案，包括积极的治疗方法和饮食调整，有更有利的结果。
Background Swallowing dysfunction after stroke is common, but there is little reliable evidence for how the disorder should be managed. This study compared standard low-intensity and high-intensity behavioural interventions with usual care for dysphagia.Methods 306 patients with clinical dysphagia admitted to hospital with acute stroke were randomly assigned to receive usual care (n=102), prescribed by the attending physician; standard low-intensity intervention (n=102), comprising swallowing compensation strategies and diet prescription three times weekly for up to a month; or standard high-intensity intervention and dietary prescription (n=102), at least daily for up to a month. The primary outcome measure was survival free of an abnormal diet at 6 months. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00257764. Findings 60 patients died and three patients were lost to follow up before the 6-month analysis. Of patients randomly allocated usual care, 56% (57/102) survived at 6 months free of an abnormal diet compared with 67% (136/204) allocated standard swallowing therapy (relative risk 1.9, 95% CI 0.98-1.45). Standard swallowing therapy was associated with a non-significant trend toward a reduction in death (0.80, 0.5-1.3), institutionalisation (0.69, 0.4-1.1), and dependency (1.05, 0.8-1.3); a significant reduction in swallowing-related medical complications (0.73, 0.6-0.9), chest infection (0.56, 0.4-0.8), and death or institutionalisation (0.73, 0.55-0.97); and a significant rise in the proportion of patients regaining swallowing function (1.41, 1.03-1.94) by 6 months. Compared with usual care and low-intensity therapy, high-intensity therapy was associated with an increased proportion of patients who returned to a normal diet (p=0.04) and recovered swallowing (p=0.02) by 6 months.Interpretation These data show a consistent trend towards more favourable outcomes in dysphagic stroke patients who are assigned a standard programme of early behavioural swallowing intervention, including active therapeutic approaches and dietary modification.