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目的 探讨纤维鼻咽喉镜吞咽功能检查(FEES)在急性脑卒中患者吞咽功能评估中的应用价值.方法 对95例急性脑卒中患者进行FEES检查,以食物渗漏、穿透、误吸和潴留为主要观察指标,比较误吸患者及无误吸患者的肺炎发生情况,根据FEES检查结果 对患者进食途径给予相应的建议.结果 FEES检查显示,入组的95例患者中有45例存在食物渗漏,34例存在穿透,47例存在误吸,53例存在潴留;检查中出现误吸的患者肺炎发生率显著高于无误吸的患者(分别为5.5%和O%,P＜0.001,OR=1.343,95%CI为1.136～1.588).根据FEES检查结果 ,建议34例患者可正常经口进食,27例患者需要接受代偿性治疗措施,34例患者需要鼻饲饮食.所有患者均未出现鼻出血、气道痉挛和心率血压骤然变化等严重并发症.结论 FEES检查在急性脑卒中患者吞咽障碍的诊断和处理中是一个非常有价值的评估工具.

Objective To evaluate the clinical value of fiber-optic endoscopic examination of swallowing (FEES)in the diagnosis and treatment of dysphagia in acute stroke patients.Methods Ninety-five patients with acute stroke received FEES from April 2005 to December 2007.Aspiration,spillage,penetration and residue welre observed.The relation between aspiration during FEES and pneumonia post-stroke Was analyzed.Diet protocols were suggested according to the FEES results.Epistaxis,airway compromise and significant changes in heart rate or blood pressure before and after the examination were assessed to determine the safety of FEES.Patients were also asked to rate the level of discomfort of the examination.Results Of the 95 patients,45 exhibited spillage,34 had penetration,47 aspirated and 53 had residue.The patients with aspiration had a significantly higher incidence of pneumonia than those without aspiration(25.5%vs 0%).Based on the FEES findings,a normal diet was recommended for 34 of the patients,27 required compensatory management and 27 received nasogastric tube feeding.No such adverse effects as epistaxis,airway compromise or significant changes in heart rate or blood pressure were noted during the period of the study.Eighty-two patients reported no discomfort or mild discomfort during FEES.Conclusion FEES can be a valuable tool for evaluating and managing dysphagia in acute stroke patients.