Ho Yi-Hui, Liu Hsiu-Yueh, Huang Shun-Te
Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan, ROC.
Department of Environmental and Occupational Health, College of Medical, National Cheng Kung University, Taiwan, ROC.
Hu Li Za Zhi. 2014 Apr;61(2):54-62. doi: 10.6224/JN.61.2.54.
Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments.
This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units.
We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysis.
At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia.
Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.
吞咽困难是一种非常常见的中风后症状，与吸入性肺炎、营养不良及住院时间延长有关。虽然患者转入康复科后通常会持续接受吞咽困难监测，但对于吞咽困难重新评估的结果却知之甚少。
本研究调查康复科中风患者吞咽困难的患病率及体征。
我们分析了台湾南部一家医疗中心康复科收治的中风患者。研究程序包括病历审查、反复唾液吞咽测试（RSST）和改良水吞咽测试（MWST）。吞咽困难定义为RSST或MWST异常。使用JMP 9.0进行描述性统计、t检验、卡方检验和逻辑回归分析。
在临床检查中，53.61%的研究对象存在吞咽困难。卡方分析显示，五个异常体征（饮水时不能闭嘴、未咀嚼、食物卡在喉咙、明显痰鸣音、吞咽后呛咳）均与吞咽困难有关。多元逻辑回归分析显示，吞咽后呛咳是吞咽困难的一个显著预测变量。
本研究中超过半数的康复科中风患者存在吞咽困难。护士是吞咽困难患者的主要护理人员。因此，病房护士需要具备评估、识别和处理吞咽困难的技能，以提高患者安全性。
