引用本文:蒋柳结,江洪波,彭 军,阮洁贞,左凝华,林 凌,梁 乐,叶 绿,徐冰钰,江善芬,王晓刚.床旁Gugging吞咽功能筛查在急性脑梗死单病种质量管理中的应用[J].中国临床新医学,2020,13(8):794-797.
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床旁Gugging吞咽功能筛查在急性脑梗死单病种质量管理中的应用
蒋柳结,江洪波,彭 军,阮洁贞,左凝华,林 凌,梁 乐,叶 绿,徐冰钰,江善芬,王晓刚
543001 广西,桂东人民医院神经内科(蒋柳结,江洪波,阮洁贞,左凝华,林 凌,梁 乐,叶 绿,徐冰钰,江善芬),医务部(王晓刚);543001 广西,梧州市工人医院心血管内科(彭 军)
摘要:
[摘要] 目的 探讨床旁Gugging吞咽功能筛查(Gugging swallowing screen,GUSS)在急性脑梗死单病种质量管理中的应用价值。方法 选择2015-01~2015-12于该院住院治疗的急性期脑梗死患者400例,均在入院48 h内完成GUSS评分,根据患者GUSS评分进行膳食推荐及吞咽康复治疗。比较不同吞咽困难程度组间的吞咽功能恢复情况以及住院时间、肺炎发生率、抗菌素使用率、出院时转归情况。结果 400例急性脑梗死患者在入院48 h内完成首次床旁GUSS,执行率达100%。床旁GUSS结果显示,急性脑梗死患者吞咽困难的发生率为47.50%(190/400),其中轻度吞咽困难88例(46.32%),中度吞咽困难60例(31.58%),重度吞咽困难42例(22.10%)。重度吞咽困难者的TOAST分型以心源性脑栓死为主,中度吞咽困难者的TOAST分型以大动脉粥样硬化血栓形成为主,而轻度吞咽困难者的TOAST分型以大动脉粥样硬化血栓形成和腔隙性脑梗死为主。在进行干预治疗1周后,吞咽困难轻度、中度和重度患者的GUSS评分均较干预治疗前提高,差异有统计学意义(P<0.05)。吞咽困难组住院期间发生肺炎率、住院时间、抗菌素使用率和出院时转归不良率均大于非吞咽困难组,差异有统计学意义(P<0.05)。结论 床旁GUSS操作简易,可客观评价急性脑梗死患者的误吸风险及吞咽困难严重程度,降低卒中后肺炎的发生率,促进患者康复。
关键词:  Gugging吞咽功能筛查  急性脑梗死  吞咽困难  卒中后肺炎
DOI:10.3969/j.issn.1674-3806.2020.08.13
分类号:R 743.3
基金项目:广西卫健委科研课题(编号:Z2015042)
Application of bedside Gugging swallowing screen in quality management of single disease of acute cerebral infarction
JIANG Liu-jie, JIANG Hong-bo, PENG Jun, et al.
Department of Neurology, Guidong People′s Hospital, Guangxi 543001, China
Abstract:
[Abstract] Objective To explore the application value of bedside Gugging swallowing screen(GUSS) in the quality management of single disease of acute cerebral infarction. Methods Four hundred patients with acute cerebral infarction who were hospitalized in our hospital from January 2015 to December 2015 were selected. All the patients completed GUSS scores within 48 hours of admission. According to the patients′ GUSS scores, dietary recommendations and swallowing rehabilitation treatment were performed. The recovery of swallowing function, the length of hospitalization, the incidence of pneumonia, the utilization rate of antibiotics, and the outcome at discharge were compared among the groups with different degrees of dysphagia. Results All the 400 patients with acute cerebral infarction completed the first bedside GUSS within 48 hours of admission, with an implementation rate of 100%. The bedside GUSS results showed that the incidence of dysphagia in the patients with acute cerebral infarction was 47.50%(190/400), including 88 cases(46.32%) of mild dysphagia, 60 cases(31.58%) of moderate dysphagia, and 42 cases(22.10%) of severe dysphagia. The TOAST classification of severe dysphagia was mainly cardiogenic cerebral embolism; the TOAST classification of moderate dysphagia was mainly large arteries atherosclerotic thrombosis, and the TOAST classification of mild dysphagia was mainly large arteries atherosclerotic thrombosis and lacunar cerebral infarction. Compared with those before the intervention treatment, the GUSS scores of the patients with mild, moderate and severe dysphagia were higher one week after the intervention treatment, and the differences were statistically significant(P<0.05). The rate of pneumonia during hospitalization, the length of hospital stay, the utilization rate of antibiotics and the adverse outcome rate at discharge in the dysphagia group were greater than those in the non-dysphagia group, and the differences were statistically significant(P<0.05). Conclusion Bedside GUSS is easy to operate and can objectively evaluate the risk of aspiration and the severity of dysphagia in patients with acute cerebral infarction, reduce the incidence of post-stroke pneumonia, and promote the patients′ recovery.
Key words:  Gugging swallowing screen(GUSS)  Acute cerebral infarction  Dysphagia  Pneumonia after stroke