Hansen Trine S, Engberg Aase W, Larsen Klaus
Department of Neurorehabilitation, Brain Injury Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Arch Phys Med Rehabil. 2008 Aug;89(8):1556-62. doi: 10.1016/j.apmr.2007.11.063.
To investigate the status of functional oral intake for patients with severe traumatic brain injury (TBI) and time to return to unrestricted dieting; and to investigate whether severity of brain injury is a predictor for unrestricted dieting.
Observational retrospective cohort study.
Subacute rehabilitation department, university hospital.
Patients age 16 to 65 years (N=173) with severe TBI (posttraumatic amnesia from 7d to >6 mo) admitted over a 5-year period. Patients are transferred to the brain injury unit as soon as they ventilate spontaneously.
Facial oral tract therapy.
Unrestricted dieting assessed by the Functional Oral Intake Scale (FOIS).
We found that 93% of all patients had problems with functional oral intake at admission. Within 126 days of rehabilitation, 64% recovered to unrestricted dieting before discharge. The chance of returning to total oral diet depends on the severity of the brain injury and can be predicted by Glasgow Coma Scale (GCS; measured the day after cessation of sedation; Wald chi(2)=42.78, P<.01), Rancho Los Amigos Scale (RLAS) level (Wald chi(2)=11.84, P=.01), FIM instrument (Wald chi(2)=44.40, P<.01), and FOIS score at admission (Wald chi(2)=82.93, P<.01).
Impairment in functional oral intake was found to be very common for patients with severe TBI admitted to a subacute rehabilitation department. For those who recovered during hospital rehabilitation, return to unrestricted dieting happened within 126 days of rehabilitation. The chance of returning to unrestricted dieting depends on the severity of the brain injury and can be predicted by GCS score, RLAS level, FIM score, and functional oral intake at admission. These results are important when planning rehabilitation, giving information to patients and relatives, and designing efficacy studies of facial oral tract therapy, which are highly recommended.
调查重度创伤性脑损伤（TBI）患者的功能性经口进食状况以及恢复至不受限制饮食的时间；并研究脑损伤的严重程度是否可作为不受限制饮食的预测指标。
观察性回顾性队列研究。
大学医院亚急性康复科。
年龄在16至65岁之间（N = 173）、在5年期间入院的重度TBI患者（创伤后遗忘持续时间为7天至>6个月）。患者一旦自主通气，就被转至脑损伤病房。
面口部治疗。
通过功能性经口进食量表（FOIS）评估不受限制饮食情况。
我们发现，所有患者中有93%在入院时存在功能性经口进食问题。在康复的126天内，64%的患者在出院前恢复至不受限制饮食。恢复至完全经口饮食的可能性取决于脑损伤的严重程度，可通过格拉斯哥昏迷量表（GCS；在镇静停止后次日测量；Wald卡方=42.78，P<0.01）、Rancho Los Amigos量表（RLAS）水平（Wald卡方=11.84，P = 0.01）、FIM工具（Wald卡方=44.40，P<0.01）以及入院时的FOIS评分（Wald卡方=82.93，P<0.01）进行预测。
对于入住亚急性康复科的重度TBI患者，发现功能性经口进食障碍非常常见。对于那些在住院康复期间康复的患者，在康复的126天内恢复至不受限制饮食。恢复至不受限制饮食的可能性取决于脑损伤的严重程度，可通过GCS评分、RLAS水平、FIM评分以及入院时的功能性经口进食情况进行预测。在规划康复、向患者及家属提供信息以及设计面口部治疗疗效研究时，这些结果很重要，强烈推荐进行此类研究。
Zotero 插件