深层咽肌神经刺激疗法对脑卒中后吞咽障碍患者吞咽功能和营养状态的影响

Effect of deep pharyngeal nerve stimulation on swallowing function and nutritional status in patients with dysphagia after stroke

目的探讨深层咽肌神经刺激疗法对脑卒中后吞咽障碍患者吞咽功能和营养状态的影响。方法采用随机数字法将徐州市中心医院2016年1月—2018年1月间收治的166例脑卒中后吞咽障碍患者分为2组,每组83例。对照组给予康复治疗,观察组在对照组基础上加用深层咽肌神经刺激疗法治疗。治疗后,比较2组患者洼田饮水试验评分、标准吞咽功能评分(SSA)、X线吞咽造影检查评分(VFSS)、生活质量(SWAT-QOL)、日常生活活动能力(MBI)、营养状态(Hb、ALB、PAB)、吸入性肺炎与营养不良发生情况及临床疗效。结果治疗后,2组洼田饮水试验、SSA评分明显降低(P<0.05),且观察组显著低于对照组(P<0.05),2组VFSS评分明显升高(P<0.05),且观察组显著高于对照组(P<0.05)。治疗后,2组SWAT-QOL、MBI评分显著升高(P<0.05),且观察组明显高于对照组(P<0.05)。治疗后,2组Hb、ALB及PAB水平均明显升高(P<0.05),且观察组显著高于对照组(P<0.05)。治疗后,观察组吸入性肺炎发生率为8.43%,明显低于对照组的19.28%(P<0.05),营养不良发生率为10.84%,显著低于对照组的26.51%(P<0.05)。治疗后,观察组的总有效率为89.16%,明显高于对照组的68.87%(P<0.05)。结论深层咽肌神经刺激疗法能明显改善脑卒中后吞咽障碍患者吞咽功能,提高患者的日常生活活动能力及生活质量,改善患者的营养状态,降低吸入性肺炎与营养不良等并发症的发生。

Objective To investigate the effect of deep pharyngeal nerve stimulation on swallowing function and nutrition- al status of patients with dysphagia after stroke. Methods A total of 166 cases of post-stroke dysphagia patients from January, 2016 and January, 2018 in our hospital were random divided into two groups, 83 cases in each group. The con- trol group was given rehabilitation treatment, and the observation group was treated with deep pharyngeal nerve stimula- tion therapy based on control group. After treatment, Putian drinking water test scores, standard swallowing function score （SSA）, X-ray swallowing angiography test score （VFSS）, life quality （SWAT-QOL） , daily living activity （MBI） , and nutritional status （Hb, ALB, PAB） , aspiration pneumonia and malnutrition occurrence, and clinical effica- cy of two groups were compared. Results After treatment, the drinking water test and SSA score of two groups were sig- nificantly decreased （ P 〈 0.05 ）, and the observation group was significantly lower than control group （ P 〈 0.05 ）. The VFSS scores of two groups were significantly increased （ P 〈 0.05 ）. The observation group was significantly higher than control group （ P 〈 0.05 ）. After treatment, the SWAT-QOL and MBI scores of two groups were significantly increased （ P 〈 0.05 ）, and the observation group was significantly higher than control group （ P 〈 0.05 ）. After treatment, Hb, ALB and PAB levels of two groups increased significantly （ P 〈 0.05 ） , and the observation group was significantly higher than the control group （ P 〈 0.05 ）. After treatment, the incidence of inhalation pneumonia of observation group was 8.43% , which was significantly lower than that of the control group （ 19.28% , P 〈 0.05. The incidence of malnutri- tion was 10.84%, which was significantly lower than that of the control group 26.51% ）, P 〈 0.05. After treatment, the total effective rate was 89.17% in the observation group, which was significantly higher than 68.87% in the control group （P 〈 0.05 ）. Condusion Deep pharyngeal nerve stimulation can significantly improve the swallowing function of patients with dysphagia after stroke, improve their daily activities and quality of life, improve their nutritional status, and reduce the occurrence of complications such as abscess pneumonia and malnutrition.