探讨适合脑瘫吞咽障碍患儿的评估量表和康复策略

Discussion on assessment scale and rehabilitation strategies suitable for children with cerebral palsy dysphagia

目的:探讨适合福利机构脑瘫吞咽障碍患儿康复策略。方法:采用量表1、量表4和量表7分别对150例脑瘫合并吞咽障碍的患儿进行评估和疗效评定,随机分为A、B、C 3组,探讨治疗前、治疗后3个月、6个月、12个月、18个月及24个月的康复情况。结果:1同组治疗前后评分对比:C组最先出现差异有显著统计学意义;A组次之;B组最后;2治疗前后组间评分对比:A组与B组仅量表1及量表4评分24个月时差异有统计学意义;A组与C组仅量表4评分18个月时差异有统计学意义;B组与C组量表1评分18个月始、量表4评分12个月始及量表7评分6个月始差异有统计学意义;3治疗后同期3组间疗效比较:量表1差异无统计学意义;量表4的12个月及18个月和量表7的6个月始差异有统计学意义。结论:1建议采用A组间接策略+直接策略,不主张采用补偿策略;2综合使用3个量表才能对患儿吞咽能力作出全面判断。

Objective： To explore rehabilitation strategies suitable for children with cerebral palsy dysphagia in welfare institutions. Methods： Scale 1, scale 4 and scale 7 were used to assess 150 children with cerebral palsy combined with dysphagia, then the children were randomly divided into A group, B group and C group ; the rehabilitation situations before treatment, at 3, 6, 12, 18 and 24 months after treatment were researched. Results： There were statistically significant difference in scores between before and after treatment in group A, group B and group C, the appearance times of difference in group C was the earliest, followed by group A and group B ; there were statistically significant differences in scores of scale 1 and scale 4 at 24 months between group A and group B; there was statistically significant differences in score of scale 4 at 18 months between group A and group C; there were statistically significant differences in scores of scale 1 from 18 months, scale 4 from 12 months and scale 7 from 6 months; there was no statistically significant difference in curative effect of scale 1 after treatment among the three groups; there were statistically significant differences in curative effect of scale 4 at 12 and 18 months and scale 7 from 6 months among the three groups. Conclusion： Indirect strategy ＋ direct strategy are suggested in group A, it is not recommended to adopt compensatory strategies. Comprehensive application of three scales can make comprehensive judgment for swallowing function in children.