患有口咽吞咽困难的长期护理老年患者中的脱水情况。

Dehydration among long-term care elderly patients with oropharyngeal dysphagia.

作者信息

Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N, Segal R

机构信息

Shmuel Harofe Hospital, Geriatric Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Gerontology. 2007;53(4):179-83. doi: 10.1159/000099144. Epub 2007 Jan 30.

DOI:10.1159/000099144

PMID:17264513

Abstract

INTRODUCTION

Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable.

OBJECTIVE

Assessment of hydration status among elderly LTC residents with oropharyngeal dysphagia.

METHODS

A total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study. The common laboratory, serum and urinary tests were used as indices of hydration status. The results were considered as indicative of dehydration and used as 'markers of dehydration', if they were above the accepted normal values.

RESULTS

The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 +/- 1.3 vs. 2 +/- 1.4, p = 0.000). About 75% of these FOSS-2 patients had > or =4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/S(Cr)), urine/serum osmolality ratio (U/S(Osm)), and urine osmolality U(Osm), were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a 'normal' daily urine output (>800 ml/day) also had a significant number (2 +/- 1.5) of positive indices of dehydration.

CONCLUSIONS

Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S(Cr ), U/S(Osm) and U(Osm), offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.

摘要

引言

长期护理（LTC）机构的居民，尤其是存在吞咽困难且经口进食的患者，容易出现脱水。脱水的临床后果很严重。常用的反映水合状态的实验室参数的有效性远非绝对，在老年人中更是如此。然而，这些指标的组合更为可靠。

目的

评估患有口咽吞咽困难的老年长期护理机构居民的水合状态。

方法

共有28名在功能性吞咽结果量表（FOSS）上存在2级进食困难且经口进食的患者以及67名经鼻胃管（NGT）进食的长期护理机构居民进入研究。常用的实验室、血清和尿液检测被用作水合状态的指标。如果结果高于公认的正常值，则被视为脱水的指征并用作“脱水标志物”。

结果

FOSS-2组的脱水标志物平均数量显著更高（3.8±1.3对2±1.4，p = 0.000）。这些FOSS-2患者中约75%有≥4个脱水标志物，而经鼻胃管进食组为18%（p = 0.000）。少尿（<800毫升/天）在FOSS-2组中明显更常见（39%对12%，p = 0.002）。血尿素氮（BUN）、BUN/血清肌酐比值（BUN/S(Cr)）、尿/血清渗透压比值（U/S(Osm)）和尿渗透压U(Osm)高于正常值，在易发生脱水的FOSS-2组中明显更频繁。这4项指标的组合在少尿患者中占65%。相比之下，在尿量较高的患者中仅占36%（p = 0.01）。每日尿量“正常”（>800毫升/天）的患者也有相当数量（2±1.5）的脱水阳性指标。