国际功能、残疾和健康分类在脑卒中后吞咽功能障碍中的临床应用

Using the International Classification of Functioning, Disability and Health with dysphagia patients after stroke

目的观察国际功能、残疾和健康分类（ICF）60条吞咽障碍核心条目在临床脑卒中后吞咽功能障碍评定和治疗中的作用。方法选取脑卒中后吞咽功能障碍患者60例，按随机数字表法分为ICF组和对照组，每组30例。ICF组患者于收治后即开始Threats60条吞咽障碍核心条目评定，对照组患者则进行康复医学科常规吞咽功能障碍评定。评定结束后，2组患者均进行吞咽功能障碍常规康复治疗，ICF组患者在此基础上，依据ICF评估时发现的功能障碍给予相应的干预。2组患者均于治疗前、治疗4周和8周后进行洼田饮水试验分级评定，并于评估结束后行表面肌电图（sEMG）检查。结果治疗4周和8周后，ICF组的洼田饮水试验分级分别为（2．56±0．76）级和（1．46±0．32）级，分别与组内治疗前和对照组治疗后同时间点比较，差异均有统计学意义P〈0．05）；治疗4周和8周后，2组患者各肌群的吞咽时程和募集最大振幅较组内治疗前均显著改善（P〈0．05），且ICF组各肌群的吞咽时程和募集最大振幅均显著优于对照组同时间点，差异均有统计学意义（P〈0．05）。结论在常规吞咽功能障碍治疗的基础上，根据ICFThreats60条吞咽障碍核心条目的评定结果对脑卒中后吞咽功能障碍患者进行有针对性的干预，可显著改善吞咽障碍患者的洼田饮水试验分级以及各肌群吞咽时程和募集最大振幅。

Objective To test the utility of applying the 60 core items of the International Classification of Functioning, Disability and Health （ICF） to patients with dysphagia after stroke. Methods Sixty dysphagic stroke survivors were randomly divided into an ICF group and a control group, each of 30. The ICF group was eval- uated using the Threats 60 items core sets of the ICF, while the control group was assessed traditionally. Both groups were then given conventional rehabilitation training, but the ICF group was given additional intervention ac- cording to the evaluation results. Right after the treatment and four and eight weeks later, Kubota Toshio＇s drinking tests and surface electromyography （sEMG） were performed for both groups. Results The average grade in Kubota Toshio＇s drinking test fell from （2.56 ~ 0.76） after 4 weeks＇ treatment to （1.46 ~ O. 32） after 8 weeks of treatment in the ICF group. Both averages were significantly higher than before treatment and significantly higher than the control group＇s averages at the same time points. After 4 and 8 weeks of treatment, the duration of swal- lows and the maximum amplitude of the related muscles were also significantly improved compared with before treat- ment. The average swallow duration in the ICF group was significantly shorter than that in the control group, and the maximum amplitude was significantly greater. Conclusion In addition to conventional treatment, targeted intervention based on evaluation using the Threats 60 core items of the ICF can significantly improve swallowing for stroke survivors with dysphagia.