急性脑血管病患者吞咽困难的评价与康复治疗

Appraisal and Rehabilitation on Senile Cerebral Apoplexy Patients Dysphagia

目的观察急性脑血管病患者吞咽困难的康复治疗效果。方法吞咽筛选试验将入院的急性脑血管病吞咽功能障碍的患者86例,随机分为两组。康复组和对照组。通过:(1)饮水试验;(2)录像荧光吞钡检查吞咽功能;(3)吞咽能力分级评价入院时及康复治疗1个月后两组病人吞咽功能。结果30 d后,观察两组患者吞咽功能障碍改善情况,康复组未发生误吸,4例并发轻度肺部感染,治疗后痊愈;对照组发生6次误吸,12例并发不同程度的肺部感染,治疗好转10例,死亡2例。康复组和对照组病人于入院时,饮水试验为可疑者的百分率(25.6%和27.9%,χ2=0.036,P>0.05)和吞咽能力分级为轻的百分率(34.9%和37.2%,χ2=0.0001,P>0.05)无显著性差异。1个月后,康复组病人饮水试验正常及可疑者所占的百分率明显高于对照组(83.7%与30.2%,χ2=2.36,P<0.05);吞咽能力分级为正常及轻度异常者的百分率也明显高于对照组(79.1%与37.2%,χ2=2.21,P<0.05)。吞咽困难与急性脑血管病发生的病变所在大脑半球的侧别无关,与病灶所在部位有关。结论对急性脑血管病后吞咽障碍的患者进行早期康复训练,具有明显效果。

Objective Observing the rehabilitation result of senile cerebral apoplexy Patients dysphagia.Methods 86 cases of acute cerebral apoplexy dysphagia patients are tested by swallowing screening, divide them into two groups by random;rehabilitation group and control group. Adopting（1） drinking water experiment; （2）examining swallowing function by viewfinder fluorescence swallowing barium; （3） swallowing ability grading appraisal exame Patients dysphagia in admitted to hospital and in hospital a month later, Results After 30 days,dysphagia of two groups of patients has been improved;in the process of guidance,rehabilitation group is now appeared misinspimtion, two cases of patients are appeared slight lung infection,cured after treatment, control group happens to six misinspirafions, 12 cases of patients are appeared different lung infection, 10 cases of patients are cured and improved,two cases of patients are died, when rehabilitation group patients and control group patients are admitted to hospital,drinking water experiment is suspicious patients percentage （25.6% and 27.9%, x^2 =0.036, P 〉0.05） and swallowing ability grading is slight percentage （34.9% and 37.2%, x^2= 0.0001, P 〉 0.05）,they have no obvious difference,a month later, rehabilitation group patients drinking water experiment is normal, suspicious patient＇s percentage is obviously higher that control group （83.7% and 30.2%, x^2 = 2.36, P 〈 0.05）,swallowing ability grading is normal,slight different percentage is also higher than control group（79.1% and 37.2%, x^2 = 2.21, P 〈 0.05）.The occurrence of dysphagia was not directly related to the left or right hemisphere of lesion. But it was closely related to locus of lesion. Conclusion early rehabilition training for senile cerebral apoplexy dysphagia patients has an obvious effect.