Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: An evidence-based comprehensive analysis of the literature
Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: An evidence-based comprehensive analysis of the literature
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DOI：
10.1007/s00455-001-0087-3
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发表时间：
2001-09-01
期刊：
影响因子：
2.6
通讯作者：
Turkelson, CM
中科院分区：
文献类型：
--
作者：
Doggett, DL;Tappe, KA;Turkelson, CM
我们对评估吞咽以预防吸入性肺炎的方案进行了系统的文献回顾和分析。本文来源于一份关于急性脑卒中患者吞咽障碍（吞咽困难）的诊断和治疗的证据报告，该报告是我们作为一个循证实践中心（EPC）根据美国医疗保健研究与质量局（AHRQ）的合同编写的。关于吞咽困难的诊断和治疗预防肺炎的现有证据是有限的。我们在一项使用床边检查（BSE）治疗急性卒中患者的历史对照研究、一项急性卒中患者报告吞咽困难的非对照病例系列研究、一项急性卒中患者吞咽视频透视研究（VFSS）的对照病例系列研究中发现了报告的肺炎发病率；以及一项在康复中心进行吞咽评估的患者的纤维内镜吞咽检查（FEES）的历史对照研究。将这些结果与历史对照进行比较表明，吞咽困难方案的实施伴随着肺炎发病率的大幅降低。虽然所有这些方法似乎都是有效的，但现有的小规模研究无法确定BSE、VFSS或FEES的相对疗效。
We conducted a systematic literature review and analysis of programs for evaluating swallowing in order to prevent aspiration pneumonia. This article derives from an evidence report on diagnosis and treatment of swallowing disorders (dysphagia) in acute-car stroke patients prepared by us as an Evidence-based Practice Center (EPC) under contract to the U.S. Agency for Healthcare Research and Quality (AHRQ). Available evidence on the diagnosis and treatment of dysphagia for preventing pneumonia is limited. We found reported pneumonia rates in one historical controlled study of a program using bedside exams (BSE) for acute stroke patients, one uncontrolled case series study of acute stroke patient-reporting of swallowing difficulty, one controlled case series study of videofluoroscopic study of swallowing (VFSS) for acute stroke patients; and one historical controlled study of fiberoptic endoscopic examination of swallowing (FEES) for patients referred for swallowing evaluation in rehabilitation centers. Comparing these results with historical controls indicates that implementation of dysphagia programs is accompanied by substantial reductions in pneumonia rates. While all these methods appeared effective, the small sizes of available studies did not allow determination of the relative efficacy of BSE, VFSS, or FEES.