本文選題：吸入性肺炎 + 床旁飲水試驗(yàn)�。� 參考：《遼寧醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 隨著我國(guó)老齡化進(jìn)程的加快，老年吸入性肺炎的發(fā)生和發(fā)展正逐漸受到重視，但對(duì)吸入性肺炎的診斷仍局限于臨床癥狀及體征的觀察，尚缺乏統(tǒng)一的“金標(biāo)準(zhǔn)”。床旁飲水試驗(yàn)操作簡(jiǎn)單、方便，患者耐受性好，為此本文探討床旁飲水試驗(yàn)的操作方法和觀察指標(biāo)，同時(shí)結(jié)合纖維支氣管鏡檢查對(duì)吸入性肺炎患者的預(yù)防和診斷的正確性進(jìn)行評(píng)估。 方法 明確診斷吸入性肺炎（AP）患者46例，社區(qū)獲得性肺炎（CAP）患者30例，慢性阻塞性肺疾病（COPD）患者21例入選本次研究。3組患者在病情穩(wěn)定后、意識(shí)清醒的狀態(tài)下，由同一名醫(yī)生分別進(jìn)行飲水試驗(yàn)，記錄所用時(shí)間、觀察吞咽過(guò)程以及飲水時(shí)出現(xiàn)的不正常的現(xiàn)象，，并進(jìn)行數(shù)據(jù)統(tǒng)計(jì)。在吸入性肺炎組患者知情同意的情況下，在禁食2小時(shí)以后行纖維支氣管鏡檢查，做FEES評(píng)分，觀察嘔吐反射和聲門閉合情況。 結(jié)果 3組患者年齡分布無(wú)統(tǒng)計(jì)學(xué)差異（p=0.17）、CURB-65評(píng)分結(jié)果無(wú)統(tǒng)計(jì)學(xué)差異（p=0.42）。3組患者飲水相同體積時(shí)所用時(shí)間顯著不同，并具有統(tǒng)計(jì)學(xué)意義（p＜0.01）。并且，吸入性肺炎組患者出現(xiàn)中斷或者哽噎、不正常吞咽現(xiàn)象的頻率也明顯增高。吸入性肺炎組患者同意行纖維支氣管鏡檢查者共42例，F(xiàn)EES評(píng)分平均值為5.50±1.35，有6例（14.29%）評(píng)分≤4分，36例＞4分。以AP患者喝完10ml溫水所用時(shí)間＞5s為標(biāo)準(zhǔn)，纖維支氣管鏡檢查和床旁飲水試驗(yàn)兩種方法診斷吸入性肺炎的結(jié)果相同（p＞0.1）。 床旁飲水試驗(yàn)不僅可以用于輔助診斷吸入性肺炎患者，還可以指導(dǎo)吸入性肺炎的分級(jí)預(yù)防和治療，有較好的臨床應(yīng)用價(jià)值。輔助纖維支氣管鏡檢查可增加其診斷的可靠性。
[Abstract]:PurposeWith the acceleration of aging process in China, the occurrence and development of inhaled pneumonia in the elderly is being paid more and more attention. However, the diagnosis of aspiration pneumonia is still limited to the observation of clinical symptoms and signs, and there is still a lack of unified "gold standard".The operation of bedside drinking water test is simple, convenient and patient tolerance is good. Therefore, this paper discusses the operation method and observation index of bedside drinking water test.At the same time, the prevention and diagnosis of aspiration pneumonia were evaluated by fiberoptic bronchoscopy.MethodForty-six patients with inhaled pneumonia (APP), 30 patients with community-acquired pneumonia (CAP) and 21 patients with chronic obstructive pulmonary disease (COPD) were included in this study group.The drinking test was conducted by the same doctor to record the time used to observe the abnormal phenomena in the process of swallowing and drinking water and to carry out statistics.With the informed consent of the patients with aspiration pneumonia, fiberoptic bronchoscopy, FEES score, vomiting reflex and glottic closure were performed 2 hours after fasting.ResultThere was no statistical difference in age distribution among the three groups. There was no statistical difference in the score of CURB-65. There was no significant difference in the time used for drinking water of the same volume in the p0. 42. 3 group, and the difference was statistically significant (P < 0. 01).The frequency of abnormal swallowing was also significantly increased in patients with aspiration pneumonia.The average FEES score of 42 patients with aspiration pneumonia was 5.50 鹵1.35, with 6 patients with 14. 29) scores 鈮

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