易化技术治疗延髓性麻痹吞咽障碍的临床观察

Swallowing training for treating dysphagic patients with medulla stroke or post-radiotherapeutic encephalopathy

目的:探讨易化技术对延髓性麻痹的治疗效果。方法:43例延髓梗死和放射性脑病所致的延髓性麻痹患者随机分为治疗组和对照组,治疗组(n=21)接受吞咽训练和常规药物治疗,对照组(n=22)仅接受常规药物治疗,以饮水试验和临床评定来评价疗效。结果:吞咽训练前治疗组饮水试验评分5分12例、4分9例,即无正常及可疑,100%异常,治疗后4分1例、3分4例、2分10例、1分6例,即正常6例(28.6%),可疑10例(48.6%),异常5例(23.8%),吞咽功能好转非常显著(P<0.001)。对照组初次评分为5分12例、4分10例,即无正常及可疑,100%异常,常规治疗后5分7例,4分9例、3分5例、2分1例,即异常21例(95.5%),可疑1例,前后比较差异显著(P<0.05),两组比较P<0.001。临床评定两组有效率分别为90.5%和40.9%(P<0.01),治疗组的吞咽能力改善明显优于对照组。结论:吞咽训练能显著提高延髓性麻痹患者的吞咽能力。

Objective:To survey the effect of swallowing training on dysphagic patients with bubar palsy.Method: Thirty-six medullary stroke patients and 7 post-rediotherapeutic encephalopathy patients were divided into 2 groups: swallow-training group(n=21) was treated with swallowing training and routine medication therapy,control group(n=22) was treated with routine medication only.The patients were assessed with water-swallow test and clinical swallowing assessment before treatment beginning and discharge.Result:The swallow-training group patients at first assessment and after treatment assessment of water-swallow test was 12 vs 0 in stage V, 9 vs 1 in stage IV,0 vs 4 in stage III, 0 vs 10 in stage II and 0 vs 6 in stage I(P<0.001), the control group patients at first assessment and before discharge assessment of water-swallow test was 12 vs 7 in stage V,10 vs 9 in stage IV, 0 vs 5 in stage III and 0 vs 1 in stage II(P<0.05), the scores of swallow-training group were better than control group after treatment(P<0.001). In clinical swallowing assessment, the efficiency were 90.5% and 40.9% respectively,P<0.01.Conclusion:Swallowing training can improve the swallow ability of bulbar pulsy patients.