电视透视吞咽检查指导吞咽障碍康复治疗的疗效观察

Videofluoroscopic swallowing study in planning dysphagia treatment

目的探讨电视透视吞咽检查（VFSS）指导脑卒中后吞咽障碍康复治疗的应用价值。方法将80例吞咽障碍患者随机分为治疗组及对照组，2组患者人院第1天及第28天进行VFSS检查，治疗组另外每周进行1次VFSS检查。2组均接受常规肢体运动功能训练，对照组患者根据第1次VFSS检查结果选择相应训练方法及冰刺激；治疗组除给予冰刺激外，还根据每周VFSS检查结果选择对应训练方法。于治疗4周后采用饮水试验分级、吞咽障碍分级及VFSS对患者治疗前后吞咽功能进行评定。结果治疗组患者根据每周VFSS检查结果及时调整治疗方案，第2、3、4周时调整治疗方案的患者比例分别为20．6％、40．7％和15．8％。2组患者治疗前饮水试验分级：吞咽障碍分级及VFSS检查结果比较，组间差异均无统计学意义（P〉0．05）；经相应治疗后，发现2组患者饮水试验分级、吞咽障碍分级及碘剂口、咽通过时间均较治疗前明显好转，差异具有统计学意义（P〈0．05），并且以治疗组的改善幅度较显著，与对照组比较。组间差异具有统计学意义（P〈0．05）。结论采用连续VFSS指导吞咽障碍康复训练具有治疗针对性强、疗效好等优点，可进一步改善脑卒中吞咽障碍患者吞咽功能，疗效明显优于传统吞咽康复治疗。

Objective To explore the application of videofluoroscopic swallowing study （VFSS） in the treatment of dysphagia post-stroke. Methods Eighty patients were assigned into control and treatment groups. Both groups accepted routine drug treatments and physical therapy, and all patients underwent VFSS on the I st and 28th day of the study. The patients in the treatment group accepted weekly VFSS in addition, and their swallowing training schedules were formulated according to the VFSS assessment results. Water drinking tests and deglutition disorders were adopted to assess the patients＇ swallowing function before and after therapy. Results In treatment group, where the therapy schedule was adjusted using VFSS every week, the adjustment proportion at the 2nd, 3rd and 4th week was 20.6% , 40.7% and t5.8% , respectively. Before treatment there was no difference between the two groups with regard to water drinking, deglutition or VFSS scores. After training the water drinking and deglutition results and the time for iodine to transit the oral cavity and pharynx all improved significantly in both groups. The improvements in the treatment group were significantly greater than in the control group. Conclusions Swallowing training based on videofluoroscopic assessment can significantly alleviate post-stroke dysphagia.