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Rehabilitation Practice and Science

Translated Title

中風後急性／亞急性期吞嚥困難病患鼻胃管拔除之相關因子研究

Abstract

Purpose: Stroke is a common cause of dysphagia, and persistent post-stroke dysphagia is associated with a poor outcome and an increased mortality rate. Nasogastric tubes (NGTs) are frequently the recommended method for the safe administration of nutrition and hydration in stroke patients. However, prolonged use of NGTs can lead to complications, such as gastro-esophageal reflux and aspiration pneumonia. The purpose of this study was to determine the factors associated with NGT removal in patients with post-stroke dysphagia. Method: This was a retrospective study. We recruited patients with post-stroke dysphagia who had received feeding either partially or totally via NGT and had accepted swallowing training for at least six times from April 1, 2015 to December 31, 2015. The patients were divided into two groups based on whether their NGT had been removed before discharge from the hospital or not. Demographic characteristics (such as age, sex, risk factors associated with stroke, stroke type, and complications), duration of swallowing training, National Institutes of Health Stroke Scale (NIHSS), Barthel Index, modified Rankin Scale, Functional Independence Measure (FIM), and Mini-Mental Status Examination (MMSE) scores were assessed and analyzed. The Functional Communication Measure Swallowing Subscale (FCMs-swallowing) and Functional Oral Intake Scale (FOIS) were used to evaluate swallowing function. Results: A total of 113 outpatient subjects were recruited, and the NGT removal rate was 26.4%. Patients were classified into either a NGT removal (n = 30) or a non-removal (n = 83) group. Patients in the non-removal group were older (70.5 ± 12.2 vs. 65.0 ± 14.9 years; p = 0.048), were more likely to have had a previous stroke (25.3% vs. 3.3%; p = 0.007), and had poorer cognitive function (MMSE: 12.7 ± 10.1 vs. 21.4 ± 9.8; p = 0.005), lower FIM scores (49.4 ± 18.0 vs. 65.2 ± 21.3; p = 0.002), and a tendency toward higher NIHSS scores (14.0 ± 6.8 vs. 11.1 ± 6.3; p = 0.059). There were no significant differences in the duration and strategy of swallowing training between the two groups. However, the removal group showed better swallowing function on initial evaluation and greater changes in FCMs-swallowing and FOIS scores after treatment (p ＜ 0.001). Conclusion: Among stroke patients who receive NGT, younger age, no previous stroke history, better cognitive function, higher FIM scores, better initial swallowing function, and more improvement after swallowing training were all factors that were associated with a greater chance of NGT removal. Therefore, when deciding whether to remove NGTs in stroke patients, it is important to consider the above mentioned factors.

Language

Traditional Chinese

First Page

217

Last Page

223

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