老年首次急性梗塞性腦中風後進食功能之恢復情形

Recovery of Oral Intake Function in Elderly Patients with First-Ever Acute Ischemic Stroke

許雅芳(Ya-Fang Hsu) ； 林彣芷(Wen-Chih Lin) ； 胡靜宜(Ching-I Hu) ； 柯美如(Mei-Ju Ko) ； 張嘉祐(Chia-Yu Chang) ； 胡慶文(Hing-Man Wu) ； 周偉倪(Willy Chou)

《台灣復健醫學雜誌》 43卷1期 (2015/03) Pp. 33-40

https://doi.org/10.6315/2015.43(1)04

摘要

研究目的：老化會影響吞嚥功能，特別是有罹患疾病的老年人。已有文獻報導長時間留置鼻胃管的腦中風病人會增加併發肺炎與致死率的風險。然而，僅有少數的研究討論急性腦中風後合併有吞嚥障礙的病人在進食能力的變化以及影響其鼻胃管移除的因子。本文的目標是探討首次急性梗塞性腦中風病人的進食功能之變化，並分析老年與非老年族群在進食能力的恢復差異。研究方法：本研究採回溯性病歷研究。對象是南部某醫學中心在2012±年3±月1±日至12±月31±日期間，所有首次急性梗塞性腦中風住院病患且有接受語言治療與評估。所收集的變數包括：年齡、性別、與中風相關的危險因子、共病症、住院總日數、美國國家衛生研究院腦中風量表（NIHSS），以及功能性進食量表（FOIS）。針對連續變項、類別變項以及次序變項分別採用獨立樣本t±檢定法、卡方檢定以及曼惠特尼檢定法來檢驗兩組病人在各項變數上是否有差異。結果：本研究共收集97±位病人，有66±位是老年組以及有31±位為非老年組（平均年齡為:77.12±6.88vs±54.16±8.81±歲）。初評資料發現，老年組有較低的FOIS±平均分數（3.48±2.12±vs±4.00±2.16），有較高的鼻胃管留置比例（53.0%±vs±38.7%），以及合併失語症的比例也較高（22.7%±vs±16.1％），但兩組未達統計差異。此外，初評的NIHSS±平均分數亦沒有組間差異。出院前評估資料發現，老年組有顯著較低的FOIS平均分數（4.44±2.02±vs±5.45±1.86;±p＜±0.05），有顯著較高的長時間鼻胃管留置比例（40.9%±vs±16.1%;±p＜0.05），以及顯著較低的鼻胃管移除率（22.9%±vs±58.3%;±p＜±0.05）。此外，非老年組有較高的FOIS±變化量、較多比例的病人可以恢復正常的進食功能，但兩組未達統計差異。結論：根據本回溯性研究，在初次中風且神經功能損傷程度近似的狀況下，65±歲以上的患者有較嚴重的吞嚥障礙，且在急性期吞嚥功能的恢復也較差。

關鍵字

吞嚥障礙 ； 功能性由口進食量表 ； 老年人 ； 腦中風

並列摘要

Introduction and Objective: The effects of aging on swallowing are particularly evident in elderly adults who are ill. Previous studies have reported that prolonged nasogastric tube (NGT) feeding in patients who have had a stroke increases the risk of pneumonia and mortality. However, few studies have investigated the recovery of oral intake function and the factors regarding NGT removal in patients with poststroke dysphagia. In the present study, we investigated the differences in oral intake function between elderly (age: ≥65 y) and nonelderly patients with first-ever acute ischemic stroke. Methods: In this retrospective study, we reviewed the medical charts of patients with first-ever acute ischemic stroke between March and December 2012 at a medical center in southern Taiwan. The patients' demographic and clinical characteristics, including age, sex, stroke risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and functional oral intake scale (FOIS) score were obtained. We used the independent t test, chi-square test, and Mann-Whitney test to compare the groups. Results: Sixty-six of the 97 enrolled patients were assigned to the elderly group and the remaining 31 were assigned to the nonelderly group (mean age: 77.12±6.88y vs 54.16±8.81 y). On initial evaluation, the elderly group exhibited a lower average FOIS score (3.48±2.12 vs 4.00±2.16), more frequent NGT insertions (53.0% vs 38.7%), and a higher incidence of aphasia (22.7% vs 16.1%); however, the difference between the 2 groups was nonsignificant. In addition, the initial NIHSS scores did not different significantly between the 2 groups. At discharge, the elderly group exhibited a significantly lower FOIS score (4.44±2.02 vs 5.45±1.86; p＜.05), significantly more frequent NGT insertion (40.9% vs 16.1%; p＜.05), and a significantly lower NGT removal rate (22.9% vs 58.3%; p＜.05). Moreover, the nonelderly group exhibited larger FOIS score changes, and was more likely to fully recover their oral intake function, although the difference between the groups was nonsignificant. Conclusions: This retrospective study revealed that when people with first-ever stroke had similar degrees of neurological impairment, those who were elderly had more severe poststroke dysphagia and poorer swallowing function recovery compared with those who were not elderly.

並列關鍵字

dysphagia ； functional oral intake scale (FOIS) ； elderly ； stroke

參考文獻

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