Westergren A
Section of Gerontology and Caring Sciences, Department of Health Sciences, Lund University.
Int Nurs Rev. 2006 Jun;53(2):143-9. doi: 10.1111/j.1466-7657.2006.00460.x.
It is highly important in nursing care for persons with stroke to screen for, assess and manage eating difficulties. The impact on eating after stroke can be of different types, comprising dysphagia as well as eating difficulties in a larger perspective. Eating difficulties can cause complications such as malnutrition, dehydration, aspiration, suffocation, pneumonia and death. There is a lack of systematic reviews about methods to be used by nurses in their screening for eating difficulties.
This review aims at systematically capturing and evaluating current peer-reviewed published literature about non-instrumental (besides pulse oximetry) and non-invasive screening methods for bedside detection of eating difficulties among persons with stroke.
A search was performed in Medline and 234 articles were obtained. After a selection process 17 articles remained, covering seven screening methods and including about 2,000 patients.
Best nursing practice for detecting eating difficulties includes as the first step the Standardized Bedside Swallowing Assessment (SSA) to detect dysphagia (strong evidence). As the second step an observation should be made of eating including ingestion, deglutition and energy (moderate evidence). Applying pulse oximetry simultaneously to SSA can possibly add to the accuracy of aspiration detection, especially silent aspiration (limited evidence). The methods should be used as a complement to interviews.
对中风患者进行进食困难的筛查、评估和管理在护理工作中至关重要。中风后对进食的影响可能有不同类型，包括吞咽困难以及更广义的进食困难。进食困难会导致营养不良、脱水、误吸、窒息、肺炎和死亡等并发症。目前缺乏关于护士用于筛查进食困难的方法的系统综述。
本综述旨在系统收集和评估当前同行评审发表的关于非仪器（除脉搏血氧饱和度仪外）和非侵入性筛查方法的文献，以用于床边检测中风患者的进食困难。
在Medline中进行检索，共获得234篇文章。经过筛选过程后，剩下17篇文章，涵盖七种筛查方法，涉及约2000名患者。
检测进食困难的最佳护理实践包括：第一步采用标准化床边吞咽评估（SSA）来检测吞咽困难（有力证据）；第二步观察进食情况，包括摄入、吞咽和能量消耗（中等证据）。在进行SSA的同时应用脉搏血氧饱和度仪可能会提高误吸检测的准确性，尤其是隐性误吸（证据有限）。这些方法应作为访谈的补充。
