早期综合康复治疗对脑卒中后吞咽障碍的影响

Effect of early comprehensive rehabilitation therapy on dysphagia in stroke patients

目的 探讨早期综合康复治疗对脑卒中后吞咽障碍的影响。方法本研究将2006年12月至2009年5月我院收治的脑卒中后伴吞咽障碍患者120例，随机分为对照组、康复训练组、康复训练加电刺激组和康复训练加电针组，每组患者30例。对照组患者仅给予常规药物治疗，康复训练组给予常规药物治疗和康复训练，康复训练加电刺激组在康复训练组治疗方法的基础上增加神经肌肉电刺激治疗，康复训练加电针组在康复训练组治疗方法的基础上增加电针治疗。治疗前及治疗4周后采用标准吞咽功能评估（SSA）以及吞咽障碍特异性生活质量量表（SWAL—QOL）来评定各组患者的吞咽功能和生活质量。结果治疗前，4组患者性别、年龄、发病到治疗时间，脑卒中性质，SSA评分，SWAL—QOL评分等一般资料比较，差异无统计学意义（P〉0．05），具有可比性。对照组治疗前、后SSA和SWAL—QOL评分组内比较，差异无统计学意义（P〉0．051，其余3组治疗前、后SSA和SWAL-QOL评分组内比较，差异均有统计学意义（P〈0．01）。治疗后，SSA和SWAL—QOL评分比较，对照组低于其余3组，差异均有统计学意义（P〈0．01）；康复训练加电刺激组与康复训练加电针组比较，差异无统计学意义（P〉0．05），但均优于康复训练组，差异均有统计学意义（P〈0．05）。结论早期综合康复治疗可促进脑卒中后吞咽障碍患者吞咽功能的恢复，并提高患者的生活质量。常规药物治疗＋康复训练＋神经肌肉电刺激治疗或常规药物治疗＋康复训练＋电针治疗吞咽障碍的疗效优于常规药物治疗和常规药物治疗＋康复训练治疗，且两者疗效相当。

Objective To explore the effect of early comprehensive rehabilitation therapy on dysphagia after stroke. Methods A total of 120 stroke patients with dysphagia were collected from December 2006 to May 2009 and divided into 3 trial groups and a control group randomly. No treatment was given to patients in the control group. Patients in trial group 1 （T1） were given rehabilitation training, while patients in trial groups 2 （T2） and 3 （T3） were treated with VitalStim and electrical acupuncture, respectively, in addition to the rehabilitation training. A standardized swallowing assessment （SSA） and the swallowing quality of life （SWAL-QOL） scale were used to evaluate all the patients before and after 4 weeks of treatment. Results No statistically significant difference was revealed before the treatment among the groups in terms of the patients＇ sex, age, course of disease, SSA or SWAL-QOL results. Statistically significant improvement was observed after treatment in the 3 trial group, but not in the control group with regard to the SSA and SWAL-QOL scores compared with those before treatment. The trial groups all had higher scores than the control group after treatment, while T2 and T3 had higher scores than T1 after treatment. There was no statistically significant difference between groups T2 and T3. Conclusions Early comprehensive rehabilitation therapy can improve swallowing and the quality of life of stroke patients with dysphagia. Rehabilitation combined with neuromuscular electrical stimulation provides effects similar to that of training combined with electrical accupuncture, and is more effective than simple training in treating dysphagia.