目的   基于决策树构建老年患者吞咽障碍预警模型。方法  采用便利取样法对宁夏银川市宁夏回族自治区人民医院老年科住院的200例老年患者进行调查。结果  200例老年患者中，吞咽障碍发生率为40.5%。依据是否发生吞咽障碍将其患者分为两组，两组患者在性别、年龄、文化程度、职业、医保类型、家庭年收入、日常生活能力、衰弱、抑郁、营养、体质指数（BMI）比较（χ ² 值分别为13.321、4.064、31.944、36.695、18.230、19.681、52.509、10.253、20.456、9.070、9.483），差异均有统计学意义（均P＜0.05）。决策树模型筛选出老年患者吞咽障碍的影响因素主要有自理能力、职业、文化程度和抑郁，决策树模型受试者工作特征曲线下面积为0.862，灵敏度为79.8%，特异度为79.0%，P＜0.001。结论  基于自理能力、职业、文化程度和抑郁构建的决策树模型，能有效预测老年患者吞咽障碍风险。

       Objective  To construct a swallowing disorder warning model for elderly patients based on decision tree．Methods  Convenience  sampling was  used to  study  200  elderly  patients  admitted to the  geriatric  department  of  a tertiary comprehensive hospital in Yinchuan，Ningxia．Results  Among 200 elderly patients，the incidence of swallowing disorders was 40.5%．The two groups of patients were compared in terms of gender，age，education level，occupation，medical insurance type，annual family income，daily living ability，frailty，depression，nutrition，and BMI（χ ²  values were 13.321，4.064，31.944，36.695，18.230，19.681，52.509，10.253，20.456，9.070，9.483，respectively），and the  differences were  statistically significant（all P＜0.05）．The decision tree model identified the main influencing factors of swallowing disorders in elderly patients as self-care ability，occupation，education level，and depression．The Receiver Operating Characteristic curve of the decision tree model had an area under the curve of 0.862，sensitivity of 79.8%，and specificity of 79.0%，P＜0.001．Conclusions  A decision tree model based on self-care ability，occupation，education level，and depression can effectively predict the  risk of swallowing disorders in elderly patients．

目的 探讨间歇经口至食管管饲法与自创吞咽功能训练联合应用于脑卒中吞咽障碍患者的效果。方法 选取河南大学淮河医院2022年1月—2023年12月收治的50例脑卒中吞咽障碍患者,应用随机数字表法将其分为两组,每组各25例。对照组采取持续留置鼻饲的同时应用自创吞咽功能训练进行训练,观察组采取间歇经口至食管管饲的同时应用自创吞咽功能训练进行训练。对比两组吞咽障碍改善情况、干预前后营养状况指标及生活质量变化,比较两组并发症发生率。结果 观察组总有效率高于对照组（P<0.05）。干预后两组血清总蛋白、白蛋白和血红蛋白水平和体质量指数均升高,观察组高于对照组（P<0.05）。干预后两组生活质量综合评定量表评分升高,观察组高于对照组（P<0.05）。观察组并发症发生率低于对照组（P<0.05）。结论 对脑卒中吞咽功能障碍患者采取间歇经口至食管管饲法与自创吞咽功能训练,能够更有效改善患者吞咽功能,提升其生活质量,且可降低留置饲管营养支持过程中的并发症发生率。

Objective To explore the application effect of intermittent oral to esophageal feeding combined with self created swallowing function training exercises in stroke patients with swallowing disorders．Methods Fifty stroke patients with swallowing disorders admitted to our hospital from January 2022 to December 2023 were selected and divided into two groups by random number table method,both with 25 cases．Control group patients received continuous nasogastric feeding while using solf created swallowing function training exercises for training,while observation group patients received intermittent oral to oesophageal tube feeding and using solf created swallowing function training exercises for training．The improvement of swallowing disorders,changes in nutritional status indicators and quality of life before and after the intervention were compared,and also the frequency of complications．Results The observation group was generally more effective than the control group（P<0.05）．After intervention,the serum total protein,albumin hemoglobin,and BMI levels of both groups of patients increased,with the observation group being higher than the control group（P<0.05）．After the intervention,GQOLI-74 score increased in both groups,and the observation group was higher than the control group（P<0.05）．The complication rate was lower in the observation group（P<0.05）．Conclusions The intervention method of intermittent oral to esophageal tube feeding combined with self created swallowing function training exercises can further improve the swallowing function of stroke patients with swallowing dysfunction,improve their quality of life,and reduce the occurrence of complications during the nutritional support process of feeding tubes．

吞咽障碍是慢性阻塞性肺疾病（COPD）的常见并发症之一,并且是COPD急性加重的危险因素之一,对患者预后造成不良影响。对COPD患者吞咽障碍的发生及严重程度进行准确的评估,是进行科学管理的首要前提。本文对COPD吞咽障碍评估工具的基本特点、应用现状及发展现状进行综述,为临床医务人员选择评估工具提供借鉴。

Dysphagia is one of the common complications of chronic obstructive pulmonary disease（COPD）,and is one of the risk factors of acute exacerbation of COPD,which has adverse effects on the prognosis of patients．Accurate assessment of the occurrence and severity of dysphagia in COPD patients is the first step for scientific management．In this paper,the basic characteristics,application status and development status of assessment tools for COPD patients with dysphagia are reviewed,which can provide reference for the selection of assessment tools for clinical medical staff．

目的 探讨K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者康复的影响因素。方法 采用回顾性分析法,收集K点刺激联合吞咽-摄食管理下的516例颅脑外伤术后吞咽障碍患者临床资料,根据吞咽障碍疗效分为有效组和无效组,采用Logistic回归分析其影响因素。结果 516例患者中,有效者479例,占92.93%;无效者37例,占7.17%。2组在性别、年龄、文化程度、有无慢性病、有无留置鼻饲管、鼻饲管留置天数方面比较差异无统计学意义（P>0.05）;在吞咽障碍分级、有无并发症、管理依从性和知识掌握程度比较差异有统计学意义（P<0.001）。Logistic回归分析结果显示,吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是影响康复效果的独立危险因素（OR分别为6.455、0.011、1.074、0.084,P<0.001）。结论 吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者吞咽功能康复的影响因素,神经外科医护人员应根据上述因素制定干预措施,以进一步提高干预效果,改善患者生活质量。

       目的  探讨功能性经口摄食分级的吞咽管理对高龄吞咽障碍患者的应用效果。方法  选取2022年5月—2024年5月暨南大学附属广州市红十字会医院收治的80例高龄吞咽障碍患者作为研究对象，应用随机数字表法将其分为观察组与对照组，各40例。对照组患者实施常规干预，观察组实施功能性经口摄食分级的吞咽管理干预，对比两组患者干预效果、干预前后的吞咽功能与营养状况、吞咽障碍相关并发症发生率，以及干预前后两组生活质量变化。结果  观察组总有效率为92.50%，高于对照组的72.50%（χ ² =5.541，P=0.019）；两组干预后综合性营养评估法（SGA）、进食评估问卷调查工具-10（EAT-10）评分均降低，且观察组［（6.62±1.24）（15.26±3.42）分］低于对照组［（10.85±2.32）（23.51±4.37）分］，对比差异有统计学意义（t分别为10.170、9.403，P＜0.05）；观察组吞咽障碍相关并发症发生率17.50%低于对照组42.50%（χ ² =5.952，P=0.015）；两组干预后生活质量综合评定量表（GQOLI-74）相关维度物质评分均升高，且观察组患者GQOLI-74相关维度物质生活（16.62±2.24）、心理功能（18.26±4.42）分、社会功能（21.62±3.66）分、躯体功能（23.26±4.37）分均高于对照组［（13.25±3.32）（13.51±2.37）（15.26±2.35）（16.62±3.73）］分，对比差异有统计学意义（t分别为5.322、5.990、9.248、7.309，P＜0.05）。结论  功能性经口摄食分级的吞咽管理对高龄吞咽障碍患者干预效果显著，且可提升其吞咽功能，改善营养状况，同时可辅助降低吞咽障碍相关并发症发生率，提高患者生活质量。

       Objective  To explore the application effect of Functional Oral Intake Scale（FOIS）swallowing management on elderly patients with swallowing disorders．Methods  A total of 80 elderly patients with dysphagia admitted to the Guangzhou Red Cross Hospital Affiliated to Jinan University from May 2022 to May 2024 were selected as research subjects．They were divided into an observation group and a control group，with 40 cases in each group，using a random number table method．The control group received routine intervention，while the observation group received FOIS swallowing management intervention．The intervention effects were compared between the two groups，including pre and post intervention，swallowing function and nutritional status，incidence of swallowing related complications，and changes in quality of life before and after the intervention．Results  The total effective rate of the observation group was 92.50%，which was higher than the 72.50% of control group（χ ² =5.541，P=0.019）．After the intervention，the comprehensive nutrition assessment（SGA）and the feeding assessment instrument-10（EAT-10）were decreased，and the observation group （［6.62±1.24］and［15.26±3.42］） were lower than the control group （［10.85±2.32］and［23.51±4.37］），and the comparative difference was statistically significant（t=10.170，9.403，P＜0.05）．The incidence of complications related to swallowing disorders in the observation group was 17.50%，lower than that in the control group was 42.50%（χ ² =5.952，P=0.015）．After intervention，the scores of GQOLI-74 related dimensions were increased in both groups．In addition，GQOLI-74 related dimensions of material life（16.62±2.24）scores，psychological function（18.26±4.42）scores，social function（21.62±3.66）scores，physical function（23.26±4.37）scores in observation group were higher than those in control group （［13.25±3.32］，［13.51±2.37］，［15.26±2.35］，［16.62±3.73］），and the difference was statistically significant（t=5.322，5.990，9.248，7.309，P＜0.05）．Conclusions  The swallowing management of FOIS has a significant intervention effect on elderly patients with swallowing disorders，and can improve their swallowing function，nutritional status，and assist in reducing the incidence of swallowing disorder related complications，thereby improving the quality of life of patients．