| ObjectivesTo observe the clinical effect of intermittent oro-esophageal tube feeding in the treatment of swallowing disorder caused by true bulbar paralysis after stroke,which might provide some guidance for clinical treatment.MethodsSixty cases of true bulbar paralysis after stroke were enrolled and randomly divided into the intermittent oro-esophageal tube feeding group and the persistent naso-gastric tube feeding group.Both groups of patients were given routine rehabilitation function training of swallowing on basic routine drug therapy,including direct training,indirect training and compensatory diet.The direct training method adopts the self-made lotus root powder to carry on the direct feeding training to the true bulbar paralysis patient after stroke,the indirect training method adopts Mendelssohn and other techniques to carry on the swallowing disorder treatment,the compensatory diet method uses the posture change way to enable the patient to eat more safely and effectively.During the treatment,the two groups were given enteral nutrition support by intermittent oro-esophageal tube feeding and persistent naso-gastric tube feeding,respectively.At the same time,the nutritional indexes,swallowing function,stroke-associated pneumonia and the results of depression screening scale were compared between the two groups within 24 hours after admission and 2 weeks after treatment.ResultsDemographic and clinical characteristics of patients in the two groups,including sex,age,course of disease,smoking history,medical history,neurological deficit score,etc,were not statistically significant(P>0.05).Intermittent oroesophageal tube feeding group has 18 men and 12 women,average age was 54.43±5.32 years,average duration was 18.27±3.11 days,16 smokers,17 with a history of diabetes,20 patients with hypertension,average score of neurological deficit was 8.23±1.17;the naso-gastric tube feeding group has 17 men and 13 women,average age was 55.13±5.33 years,average duration was 18.77±2.33 days,17 smokers,15 patients with diabetes history,19 patients with hypertension,average score of neurological deficit was 8.10±1.42.During the 24 h of admission,the nutritional status of the two groups was as follows.Body mass index of patients with intermittent oro-esophageal tube feeding group averaged 19.56±0.35,upper-arm circumference averaged 20.30±0.56 cm,Serum albumin averaged 31.87±0.74g/L,Serum prealbumin averaged 264.37±14.17mg/L;body mass index of patients with the persistent naso-gastric tube feeding group averaged 19.47±0.40,upper-arm circumference averaged 20.29±0.55 cm,Serum albumin averaged 31.87±0.70g/L,Serum prealbumin averaged 264.39±14.16mg/L,and there was no significant difference between the two groups(P>0.05).After 2 weeks,Body mass index of patients with intermittent oro-esophageal tube feeding group averaged 21.13±0.63,upper-arm circumference averaged 20.32±0.56 cm,Serum albumin averaged 33.69±0.74g/L,Serum prealbumin averaged 278.35±14.13mg/L;body mass index of patients with the persistent nasogastric tube feeding group averaged 19.74±0.42,upper-arm circumference averaged 20.30±0.54 cm,Serum albumin averaged 31.18±0.70g/L,Serum prealbumin averaged 266.89±14.15mg/L.At admission,both groups had a grade 1 rating on swallowing function,no oral feeding.After 2 weeks of treatment,patients with intermittent oro-esophageal tube feeding group were classified as no people at level 1 and level 2,one people at level 3,one people at level 4,two people at level 5,five people at level 6,twenty one persons at level 7;the patients in the nasogastric tube feeding group were classified as ten people at level 1,seven people at level 2,nine people at level 3,three at level 4,one at level 5,no people at level 6 and level 7.There were 18 cases of stroke-related pneumonia in the group from intermittent oro-esophageal tube feeding group,1 case after 2 weeks of treatment;17 cases of stroke-related pneumonia in the nasogastric tube feeding group at admission,and 15 cases after 2 weeks of treatment.There were 12 positive cases of depression in the group from intermittent oro-esophageal tube feeding group,2 cases after 2 weeks of treatment;11 cases of depression screening in the group of nasogastric tube feeding at admission,and 19 cases after 2 weeks of treatment.Compared with the persistent naso-gastric tube feeding group,the nutrition and swallowing function in intermittent oro-esophageal tube feeding group were better,and the positive rate of stroke-associated pneumonia and score of depression screening scale were lower.The differences were statistically significant(P<0.05).ConclusionIntermittent oro-esophageal tube feeding is more conducive to the improvement of nutrition and swallowing function in patients with true bulbar paralysis after stroke than persistent naso-gastric tube feeding,and it can help to control stroke-associated pneumonia and reduce the incidence of depression in patients,so it is worthy of clinical application. |
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