Abstract:

Objective　To evaluate the risk of aspiration and rehabilitation intervention for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods　Seventy-eight patients with AECOPD treated at Department of Respiratory Medicine, First Hospital, Guangzhou Medical University from June 2021 to April 2022were selected by the convenience sampling method, including 66 males and 12 females. They were 46-90 (72.77±11.81) years old. Among the 78 patients, 21 cases had dysphagia disorder, and the rest 57 cases did not. The risk of aspiration was assessed according to the clinical dysphagia, including comprehensive medical history assessment, oral, facial, and laryngeal function assessment, and bedside drinking and swallowing tests. According to the evaluation results, graded rehabilitation intervention was carried out. The patients' swallowing function before and after the intervention and the recovery effects were compared. χ² and Mann-Whitney U tests were applied. Results　Among the 78 patients, 21 cases had dysphagia disorder, accounting for 26.93%. Advanced age, mMRC score, and self-care ability of daily life were the factors affecting the patients' abnormal swallowing function of (χ²=4.262, 11.001, and 10.645; all P<0.05). Swallowing rehabilitation intervention could improve their swallowing function. The passing rates of repeated saliva swallowing test, water swallowing test, and swallowing paste test were better after than before the intervention [61.53% (48/78) vs. 44.87% (35/78), 74.36% (58/78) vs. 52.56% (41/78), and71.79% (56/78) vs. 55.13% (43/78)], with statistical differences (χ²=4.351, 7.989, and 4.672; all P<0.05). Conclusions　Identifying the risk factors of aspiration in patients with AECOPD and guiding the nursing measures of swallowing rehabilitation can improve their swallowing function and reduce the complications and disease burden of aspiration.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Aspiration, Risk assessment, Dysphagia, Intervention

摘要：

目的　对慢性阻塞性肺疾病急性加重期（AECOPD）患者进行误吸风险评估及康复干预。方法　采用便利抽样方法，选取2021年6月至2022年4月在广州医科大学附属第一医院呼吸内科住院的AECOPD患者为研究对象，共纳入78例患者，其中男66例，女12例，年龄46～90（72.77±11.81）岁。78例AECOPD患者中，有吞咽障碍者21例，无吞咽障碍者57例。根据临床吞咽障碍评估患者的误吸风险，包括全面病史评估、口颜面功能和喉部功能评估以及床旁的饮水及吞糊试验；根据评估结果进行分级康复干预，比较患者干预前后的吞咽功能情况及康复效果。统计学方法采用χ²检验、Mann-Whitney U检验。结果　78例患者中，有吞咽障碍者，占26.93%（21/78）；高龄、改良的英国医学研究委员会呼吸困难量表（mMRC）评分及日常生活自理能力是影响患者吞咽功能异常的因素（χ²=4.262、11.001、10.645，均P<0.05）；吞咽康复干预可改善患者的吞咽功能，干预后，反复唾液吞咽试验通过率、洼田饮水试验通过率及吞糊试验通过率均较干预前好转［61.53%（48/78）比44.87%（35/78）、74.36%（58/78）比52.56%（41/78）、71.79%（56/78）比55.13%（43/78）］，差异均有统计学意义（χ²=4.351、7.989、4.672，均P<0.05）。结论　识别AECOPD患者误吸的危险因素，并指导吞咽康复护理措施可改善患者的吞咽功能，减少误吸并发症和疾病负担。

关键词:

慢性阻塞性肺疾病急性加重期, 误吸, 风险评估, 吞咽困难, 干预