吞咽训练对卒中后吞咽障碍患者营养状况的影响

Effect of swallowing training on nutritional status in patients with post-stroke dysphagia

目的探讨吞咽功能康复训练对卒中后吞咽障碍患者营养状况的影响。方法纳入经视频X线透视吞咽功能检查(VFSS)确诊的卒中后吞咽障碍患者63例,均给予鼻胃管鼻饲等基础治疗。根据是否进行吞咽功能训练,随机分成训练组(31例)及对照组(32例)。训练组患者接受吞咽功能训练4周。入组前、入组后1、3、6个月比较两组患者的血红蛋白(Hb)、总蛋白(TP)、血清白蛋白(ALB)、健侧肱三头肌皮褶厚度、健侧上臂围,评估两组患者的营养状况。结果①治疗后3个月和6个月,训练组的ALB、TP、Hb、健侧肱三头肌皮褶厚度及上臂围均高于对照组,差异有统计学意义,均P<0.05。②训练组患者在治疗各阶段的ALB、TP、Hb、健侧肱三头肌皮褶厚度及上臂围比较,差异有统计学意义,均P<0.05。治疗后1个月最低,此后逐渐升高。③对照组患者在治疗各阶段的ALB、TP、上臂围比较,差异有统计学意义,均P<0.05,均呈下降趋势。结论经过有针对性的康复训练,可改善卒中后吞咽障碍患者的营养状况。

Objective To investigate the effect of swallowing training on the nutritional status in pa-tients with post-stroke dysphagia. Methods A total of 63 with post-stroke dysphagia diagnosed with the videofluoroseopic swallowing study （VFSS） were enrolled. They were all received nasogastric tube feeding. The patients were randomized divided into either a training group （n = 31 ） or a control group （n = 32） according to whether they were underwent swallowing training or not. The patients in the training group received swallowing training for 4 weeks. The hemoglobin （ Hb ）, total protein （ TP ）, serum albumin （ALB） , contralateral triceps skinfold thickness and contralateral arm circumference in both groups were compared at 1, 3 and 6 months before and after enrollment. The nutritional status of the patients in both groups was evaluated. Results ①ALB, TP, Hb, contralateral triceps skinfold thickness and upper arm circumference in the training group were higher than those in the control group at 3 and 6 months after treat- ment （P 〈0.05 or P 〈0.01 ）. ②There were significant differences in ALB, TP, Hb, eontralateral triceps skinfold thickness and upper arm circumference at all stages of treatment in the training group. The above nutritional parameters were the lowest at 1 month after treatment, and then increased gradually. ③There were significant differences in ALB, TP, and upper arm circumference at all stages of treatment in the con-trol group. These nutritional parameters showed a downward trend. Conclusion After the targeted reha- bilitation training, it may improve the nutritional status of the patients with post-stroke dysphagia.