Clinical effects of intermittent oro-esophageal tube feeding combined with Xuanqiaoliyan decotion in stroke patients with dysphagia / 中华危重病急救医学

Objective:To investigate the clinical effects of intermittent oro-esophageal tube feeding (IOE) combined with Xuanqiaoliyan decotion in stroke patients with dysphagia.Methods:A prospective study was conducted. Stroke patients with dysphagia admitted to Yidu Central Hospital Affiliated Hospital of Weifang Medical University from January 2018 to December 2019 were enrolled. According to the simple random sampling method, the patients were divided into control group and observation group, with 50 cases in each group. The control group was given routine swallowing function training, including low-frequency pulse electrical stimulation, swallowing function training and acupuncture treatment. The observation group was given IOE and Xuanqiaoliyan decoction (prescription composition: Rhizoma acori tatarinowii 15 g, Radix polygalae 10 g, Rhizoma gastrodiae 15 g, Arisaema cum bile 6 g, Rhizoma typhonii 6 g, Scorpio 6 g, Bombyx batryticatus 6 g, Perilla frutescens 10 g, Rhizoma pinelliae 10 g, Pericarpium citri reticulatae 10 g, Rhizoma zingiberis recens 3 tablets, decoction 200 mL, twice in the morning and evening by oral or nasal feeding) on the basis of the control group. Both groups were treated for 14 days. The standard swallowing function assessment (SSA) and water swallow test were used to evaluate the swallowing function before and after treatment. The time required for the improvement of swallowing function, total hospitalization time and the therapeutic effects were observed and the safety assessment was conducted. Results:There were no significant differences in the gender, age, course of disease, and location and frequency of stroke between the two groups. After treatment, both the SSA scores in the two groups were decreased, and the grading of water swallow test was improved. The SSA scores in the observation group were significantly lower than that in the control group (19.8±1.8 vs. 23.2±3.2, P < 0.05), the recovery degree of water swallow test was higher than that in the control group [complete recovery (cases): 18 vs. 13, basic recovery (cases): 23 vs. 18, effective (cases): 9 vs. 19, χ 2 = -2.107, P = 0.008]. The total effective rate of swallowing function in the observation group was higher than that in the control group (94.0% vs. 80.0%, Z = 4.684, P = 0.012), the time for improvement (days: 12.8±2.6 vs. 16.9±4.3, t = 11.628, P = 0.008) and total hospitalization time (days: 20.8±4.2 vs. 33.5±5.6, t = 10.924, P = 0.015) were shorter than those in the control group. In the observation group, there was 1 case of throat discomfort during the operation of IOE, and the symptoms disappeared after the operation; there was 1 case of mild elevation of alanine aminotransferase (ALT) and blood urea nitrogen (BUN) respectively, which returned to normal after the treatment. No adverse symptoms and damage to the liver and kidney were observed in the control group. Conclusion:IOE combined with Xuanqiaoliyan decotion could significantly improve the swallowing function of stroke patients with dysphagia, shorten the hospitalization time, and improve the curative effects and lifequality.

Swallowed Oro-esophageal Tube: A Case Report / 대한연하장애학회지

Tube feeding is used to provide nutritional support to patients who have difficulty taking food orally. A nasogastric tube is commonly used for these patients but there are some complications. Therefore, the oro-esophageal tube feeding method was developed to avoid these disadvantages. A 33-year-old male with a history of right basal ganglia intracranial hemorrhage was admitted to the rehabilitation department for the treatment of dysphagia caused by a new onset left basal ganglia intracranial hemorrhage. After the videofluoroscopic swallowing study, the nasogastric tube feeding was changed to intermittent feeding via an oro-esophageal tube. Unfortunately, the patient swallowed the tube during insertion. Hence, an emergent endoscopy was performed for tube removal. This article reports a rare case of a patient who underwent oro-esophageal tube removal with an esophagogastroduodenoscopy after tube swallowing during insertion. The insertion of an oro-esophageal tube requires a careful approach after considering the cognitive function, muscle strength, and family education.

Clinical observation on the treatment of dysphagia in the patients with Wallenberg syndrome by intermittent oro-esophageal tube feeding / 肠外与肠内营养

Objective:To observe the clinical effect of intermittent oro-esophageal tube feeding (IOE) in the treatment of swallowing disorder caused by Wallenberg syndrome dorsal lateral syndrome,and to find new treatment for this kind of patients.Methods:60 cases of Wallenberg syndrome dorsal lateral syndrome were selected and randomly divided into the IOE group and the NGT group.All the patients were given swallowing function training based on controlling of the primary diseases,intervene modifiable risk factors and stroke prevention.The nutrition index and swallowing function were evaluated and compared in 24h after admission and 6 weeks after treatment.Results:Compared with the NGT group,the nutrition and swallowing function in IOE group were better.The differences were statistically significant (P ＜ 0.05).Conclusion:Intermittent oro-esophageal tube feeding is more conducive to the improvement of nutrition and swallowing function in patients with Wallenberg syndrome than NGT.

Clinical Predictors of Oro-esophageal Tube Feeding Success in Brain Injury Patients With Dysphagia

OBJECTIVE: To identify possible clinical predictors of intermittent oro-esophageal (OE) tube feeding success, and evaluate the clinical factors associated with OE tube treatment. METHODS: A total of 135 dysphagic patients were reviewed, who received OE tube treatment and were hospitalized in the department of rehabilitation medicine between January 2005 and December 2014. The 76 eligible cases enrolled were divided into two groups, based on the OE tube training success. Clinical factors assessed included age, cause of brain lesion, gag reflex, cognitive function and reasons for OE tube training failure. RESULTS: Of the 76 cases enrolled, 56 study patients were assigned to the success group, with the remaining 20 in the failure group. There were significant differences between these two groups in terms of age, gag reflex, ability to follow commands, and the score of Korean version of Mini-Mental Status Examination (K-MMSE). Location of the brain lesion showed a borderline significance. Multivariable analysis using logistic regression revealed that age, cause of brain lesion, gag reflex, and K-MMSE were the main predictors of OE tube training success. CONCLUSION: A younger age, impaired gag reflex and higher cognitive function (specifically a K-MMSE score ≥19.5) are associated with an increased probability of OE tube training success in dysphagic patients.

The Follow-up of Oro-Esophageal (OE) Tube Feeding

OBJECTIVE: Nasogastric (NG) tube feeding and percutaneous endoscopic gastrostomy (PEG) feeding have been used for dysphagic patients as tube feeding methods. In 1988, Campbell introduced oro-esophageal (OE) tube feeding as a new feeding method, but there are no reports of safety or complications of this method. METHOD: The patients 1) who could not do oral feeding and reject other tube feedings, or started oral feeding but could not be provided enough calories by this methods, 2) who had the reduced gag reflex, and 3) who had intact cognitive functions, were applied OE tube feeding and twenty patients from March 1998 to May 1999 were selected and followed up. We retrospectively reviewed their average using time, final feeding methods and complications of long term OE tube feedings. RESULTS: The average using time was 74+/-107 days. 13 patients used OE tube feedings continuously, and seven changed their feeding methods (two used NG tube feedings, one PEG, and 4 oral feedings). Only one patient was developed aspiration pneumonia, so he was prescribed for NG tube feeding, but others had no problems such as diarrhea. CONCLUSION: The complication rate of OE tube feeding was 5%, and it was relatively safe for long term users.