目的 探讨脑卒中急性期患者进食困难的类型及其相关因素。方法 2016年4月至6月,便利抽取符合标准的脑卒中患者192例,在患者发病30 d内问卷调查进食相关资料。结果 脑卒中患者中,进食困难发生率为66.67% (包括鼻饲患者15例);在经口进食177例中,进食困难113例,其中摄入障碍66例,吞咽障碍28例,精力和食欲欠佳91例,三者同时具备19例。不同美国国立卫生研究院卒中量表(NIHSS)评分、洼田饮水试验分级、构音障碍、失语、面瘫、卧床、进食协助、日常生活活动能力(ADL)评分、口腔健康状况的患者,进食困难发生率有显著性差异(P<0.05),上肢肌力和年龄分别是进食困难中摄入和吞咽障碍维度的相关因素(P<0.05),进食困难患者营养状况评分低于无进食困难患者。多元线性回归分析显示,NIHSS评分、进食协助、ADL评分及口腔健康状态与进食困难独立相关。结论 脑卒中急性期患者进食困难发生率较高,不仅有吞咽障碍,摄入困难、精力和食欲较差的发生率也很高,需要引起关注。高NIHSS评分、进食需要协助、低ADL评分及口腔健康状态异常是进食困难的独立相关因素。进食困难患者易发生营养问题。
Objective To investigate the features of eating difficulties in acute stroke patients, and its related factors. Methods From April to June, 2016, 192 stroke patients within 30 days were conveniently sampled, and investigated with a questionnaire about eating difficulties. Results The total rate of eating difficulties was 66.67% (including 15 nasal feeding patients). Among the 177 patients with oral feeding, the incidence of eating difficulties was 113, including 66 with feeding difficulties, 28 with dysphagia, and 91 with loss of energy and appetite, while there were 19 patients reporting all the problems above. The incidence of eating difficulties was various with the National Institutes of Health Stroke Scale (NIHSS) scores, Drinking Test scores, aphasia, prosopoplegia, stay in bed, eating assistance, activities of daily living (ADL) score, and oral health score (P<0.05). Myodynamia of upper limbs and ages also related with eating difficulties (P<0.05). The nutrition score of patients with eating difficulties was lower than those patients without eating difficulties. NIHSS score, eating assistance, ADL score, oral health score were the independent factors related with eating difficulties through multiple linear regression.Conclusion Eating difficulties are common in acute stroke patients, not only from dysphagia, but also about feeding difficulties and loss of energy and appetite. High NIHSS score, eating assistance, lower ADL score, bad oral health condition are the related factors of eating difficult, which may result in nutrition problems.
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