卒中相关性肺炎的危险因素分析及与吞咽功能障碍的关系

卒中相关性肺炎的危险因素分析及与吞咽功能障碍的关系摘要：

目的：了解卒中相关性肺炎（stroke-associatedpneumonia，SAP）的危险因素，探讨其与吞咽功能障碍的关系，提高卒中患者的预防和治疗水平。

方法：从2010年至2020年的文献库中检索了与SAP相关的研究，并对其中包括的危险因素和吞咽功能障碍进行了分析，通过统计学方法分析其相关性，并对预防和治疗提出建议。

结果：与SAP的相关危险因素包括年龄、性别、卒中类型、吞咽障碍等。吞咽功能障碍是SAP发生的重要因素，相关机制包括进食引起的肺吸入、吐出物反流引起的呼吸暂停等。预防措施主要包括早期评估、改善吞咽功能障碍、保持呼吸道的干燥和清洁，通过认知训练和康复运动等方法提高预防和治疗效果。

结论：SAP的发生与危险因素和吞咽功能障碍密切相关，建议对SAP高危人群进行早期干预和预防，改善吞咽功能障碍和呼吸道管理，以提高卒中患者的生存质量和预后。

关键词：SAP，卒中，吞咽功能障碍，预防，治疗

Abstract：

Objective:Toinvestigatetheriskfactorsofstroke-associatedpneumonia(SAP)andexploreitsrelationshipwithswallowingdysfunction,inordertoimprovethepreventionandtreatmentofstrokeinpatients.

Methods:RelevantstudiesonSAPfrom2010to2020weresearched,andtheriskfactorsandswallowingdysfunctionwereanalyzedbystatisticalmethods.Therelationshipbetweenthemwasanalyzedandsuggestionsweremadeforpreventionandtreatment.

Results:TherelatedriskfactorsofSAPincludeage,gender,stroketype,andswallowingdysfunction.SwallowingdysfunctionisanimportantfactorintheoccurrenceofSAP,andrelatedmechanismsincludeaspirationcausedbyfeedingandrespiratorypausecausedbyreflux.Preventionmeasuresincludeearlyassessment,improvingswallowingdysfunction,maintainingdryandcleanairways,andimprovingpreventionandtreatmenteffectsthroughcognitivetrainingandrehabilitationexercises.

Conclusion:SAPiscloselyrelatedtoriskfactorsandswallowingdysfunction.Earlyinterventionandpreventionarerecommendedforhigh-riskgroups,improvingswallowingdysfunctionandrespiratorymanagement,toimprovethequalityoflifeandprognosisofstrokepatients.

Keywords:SAP,stroke,swallowingdysfunction,prevention,treatmentIntroduction:

Stroke-associatedpneumonia(SAP)isacommoncomplicationofstrokethatcanleadtohighmorbidityandmortalityrates.SAPcanoccurduetoswallowingdysfunction,mobilityissues,andrespiratorymanagementproblemsafterstroke.UnderstandingtheriskfactorsandpreventionstrategiesforSAPisessentialinimprovingthequalityoflifeandprognosisofstrokepatients.

RiskfactorsforSAP:

SeveralriskfactorscontributetothedevelopmentofSAP.Theseincludeage,severityofstroke,impairedconsciousness,smoking,andpre-existingcomorbidities.Additionally,post-strokepneumonia(PSP)isasignificantpredictorofSAP,andstroke-induceddysphagiaisasignificantriskfactorforbothPSPandSAP.

SwallowingdysfunctionandSAP:

SwallowingdysfunctionisasignificantfactorinthedevelopmentofSAP.Strokepatientswithdysphagiaareatahigherriskofaspiratingfoodanddrinkintotheirlungs,leadingtopneumonia.Improvingswallowingfunctioninstrokepatientsthroughinterventionssuchasswallowingtherapy,texturemodification,andrepositioningduringfeedingcanreducetheriskofSAP.

RespiratorymanagementandSAP:

EffectiverespiratorymanagementiscrucialinpreventingSAP.Thisincludesearlydetectionofrespiratorycomplications,maintainingdryandcleanairways,andinstitutingappropriatetreatmentmeasurespromptly.Regularsuctioningofpatientswithtrachealintubation,carefulmonitoringofoxygenlevels,andproperpositioningcanallcontributetoreducedrisksofSAP.

Cognitivetrainingandrehabilitationexercises:

Cognitivetrainingandrehabilitationexercisescanimproveswallowingfunctionand,byextension,reducetheriskofSAP.Patientswithstroke-induceddysphagiahavebeenshowntobenefitfromcognitivetraining,includingmentalimageryandvisualcueing.Rehabilitationexercises,suchastongueandlipstrengthening,havealsobeenshowntobeeffectiveinimprovingswallowingfunctioninstrokepatients.

Conclusion:

SAPiscloselylinkedtoriskfactorsandswallowingdysfunction.Earlyinterventionandpreventionarerecommendedforhigh-riskgroups,improvingswallowingdysfunction,andoptimizingrespiratorymanagement.ReducingtheriskofSAPcanimprovethequalityoflifeandprognosisofstrokepatientsInadditiontotheinterventionsmentionedabove,otherstrategiescanalsobehelpfulinpreventingandmanagingSAP.Thesemayincludechangesinposturalpositionduringfeeding,suchassittinguprightandtiltingtheheadslightlyforward,aswellasdietarymodifications,suchassoftorpureedfoodsandthickenedliquids.

Incaseswhereswallowingfunctionisseverelycompromised,moreinvasiveinterventionsmaybenecessary.Thesecanincludetheuseoffeedingtubesorsurgicalproceduressuchasgastrostomy,whichinvolvestheinsertionofatubeintothestomachthroughtheabdominalwall.

Overall,SAPisacommonandseriouscomplicationofstrokethatcanhaveasignificantimpactonthehealthandwell-beingofpatients.However,withearlyidentificationandappropriateintervention,itispossibletoimproveswallowingfunctionandreducetheriskofaspiration.HealthcareprofessionalsshouldbevigilantinmonitoringpatientsforsignsofSAPandworkcloselywithmultidisciplinaryteamstoprovideoptimalcareandmanagementInadditiontomonitoringforSAP,thereareseveralstrategiesthathealthcareprofessionalscanusetoreducetheriskofaspirationandpromotesafeswallowinginpatientswithstroke.Theseinclude:

1.Positioning:Patientsshouldbepositioneduprightata90-degreeangleduringmealsandforatleast30minutesaftereating.Thiscanhelppreventrefluxandreducetheriskofaspiration.

2.Texturemodification:Dependingontheseverityofswallowingimpairment,patientsmayrequiremodifieddietsandfluidsthatareeasiertoswallow.Thiscanincludethickeningliquids,choppingorpureeingfoods,andavoidingcertaintypesoffoodsthataremorepronetocausingchoking,suchasnutsorpopcorn.

3.Swallowingtherapy:Speech-languagepathologists(SLPs)playakeyroleintheassessmentandmanagementofswallowingfunctioninpatientswithstroke.SLPscanprovideindividualizedtherapyprogramsthatfocusonspecificexercisesandtechniquestoimproveswallowingsafetyandefficiency.

4.Medicationmanagement:Somemedicationscanaffectswallowingfunctionorincreasetheriskofreflux,whichcancontributetoSAP.Healthcareprofessionalsshouldreviewpatients'medicationregimensandmakeadjustmentsasnecessarytopromotesafeswallowing.

5.Educationandsupport:Patientsandtheircaregiversshouldreceiveeducationonstrategie