脑卒中伴吞咽障碍患者不同训练方法的疗效观察

Observation on the curative effect of different training methods for stroke patients with dysphagia

目的探讨脑卒中伴吞咽障碍患者不同训练方法的疗效。方法选取上海市徐汇区中心医院康复科2015年1月~2016年6月收治的脑卒中伴吞咽障碍鼻饲患者60例,将其随机分为对照组A、治疗组B、治疗组C,各20例。对照组A采用神经肌肉电刺激、舌肌运动训练、下颌运动训练和进食指导;治疗组B在对照组A训练方法上再加Mendelsohn训练法;治疗组C在对照组A训练方法上再加冰柠檬刺激。每天1次,每次30 min,连续训练12 d为1个疗程。观察三组患者治疗前后摄食-吞咽功能评分的变化情况及临床疗效。结果经过治疗后,治疗组B摄食-吞咽功能评分为（4.20±1.08）分,治疗组C摄食-吞咽功能评分为（6.20±0.77）分,两组与对照组A[（2.67±0.82）分]比较,差异有高度统计学意义（P〈0.01）。治疗组B治疗有效率为80.00%,治疗组C治疗有效率为95.00%,两组与对照组A（45.00%）比较,差异有统计学意义（P〈0.05）。结论神经肌肉电刺激、舌肌运动训练、下颌运动训练、进食指导结合冰柠檬刺激能够改善脑卒中伴吞咽障碍鼻饲患者的吞咽功能,是一套实用、效果佳的脑卒中伴吞咽障碍鼻饲患者的康复训练方法。

Objective To explore the effect of different training methods for stroke patients with dysphagia. Methods Sixty stroke patients with dysphagia by nasal feeding admitted to Department of Rehabilitation Medicine, Shanghai Xuhui Central Hospital from January 2015 to June 2016 were selected. All cases were randomly divided into control group A, treatment group B and treatment group C, with 20 cases in each group. In control group A, the patients were treated with neuromuscular electrical stimulation, tongue muscle motor training, mandibular training and feeding direction; the patients in treatment group B were treated additionally with Mendelsohn method on basis of control group A;the patients in treatment group C were treated additionally with ice lemon stimulation on basis of control group A. Once a day, 30 min each time, 12 days was as a course. The changes of feeding-swallowing function scores before and after treatment, and the clinical efficacy of the three groups were observed. Results After treatment, the feeding-swallowing function score of treatment group B was（4.20±1.08） points, and the feeding-swallowing function score of treatment group C was（6.20±0.77） points, both groups had highly statistically significant differences compared with that of control group A[（2.67±0.82） points]（P〈0.01）. The effective rate of treatment group B was 80.00%, and the effective rate of treatment group C was 95.00%, both groups had statistically significant differences compared with that of control group A（45.00%）（P〈0.05）. Conclusion Neuromuscular electrical stimulation, tongue muscle training, mandibular movement training,feeding direction and lemon ice stimulation can improve the swallowing function of stroke patients with dysphagia,which is a practical and effective rehabilitation training method for the patients with dysphagia after stroke by nasal feeding.