强化呼吸功能训练对脑卒中后吞咽障碍的疗效观察

Observation of efficacy on dysphagia after stroke while strengthen the training of respiratory function

目的观察强化呼吸功能训练及常规吞咽功能训练对改善脑卒中后患者吞咽障碍的疗效.方法采用随机数字表法将2014年6月至2016年6月在康复医学科住院的脑卒中后吞咽障碍的60例患者分为对照组和治疗组,每组30例.对照组患者采用常规吞咽功能训练配合低频电刺激,吞咽功能训练分为间接训练和直接训练,包括吞咽器官的运动训练、温度刺激训练、吞咽的辅助手法和食物的形状及黏稠度的调节等,治疗组在对照组的基础上应用强化呼吸功能训练,该方法一日2次,一次10min.2组患者均于治疗前和治疗八周后采用洼田饮水试验、脑卒中患者神经功能缺损程度评分标准中的吞咽困难亚量表及Rosenbek误吸程度分级进行评定疗效.结果2组患者治疗前在洼田饮水试验、吞咽困难亚量表及Rosenbek误吸程度三方面评估相比较差异无统计学意义（P〉0.05）;经过8周治疗后2组患者在这三方面评估均较治疗前有明显改善且差异有统计学意义（P〈0.05）,同时治疗后治疗组患者在洼田饮水试验、吞咽困难亚量表及Rosenbek误吸程度三方面评分分别为[（2.03±0.68）分、（8.52±1.66）分及（2.55±1.12）分]较对照组[（2.55±0.91）分、（7.21±2.29）分及（3.55±1.82）分]有明显改善且差异有统计学意义（P〈0.05）.结论强化呼吸功能训练及常规吞咽功能训练均能有效的改善脑卒中后患者的吞咽功能,增加呼吸功能训练后效果更佳.

Objective To observe the improvnlent on patients who has dysphagia after stroke after strengthening the training of respiratory function and normal swallowing function. Methods Use Random digital table to devide 60 patients into two groups-control group and treatment group. And all patients used to be treated in the Department of Rehabilitation between June 2014 and June 2016. Ther were 30 eases in each group. The control group were treated with conventional swallowing function training with low frequency electrical stinmlation, swallowing training was divided into direct and indirect training. Including exercise training of swallowing organs, thermal stimulation training, swallowing auxiliary techniques and the adjustment of viscosity. On the basis of control group＇s training, treatment group strengthen the training of respiratory-function, which 2 times a day, once a 10 minutes. Both two groups did the test before the treatment and eight weeks after treatment. We use water swallow test, the standard of assessing degree of stroke neurological impairment on dysphagia subscale Rosenbek aspiration level grading to evaluate the efficacy. Results Before treatment, these two groups barely had difference on water swallow test, the standard of assessing degree of stroke neurological impairment on dysphagia subscale, Rosenbek aspiration level grading（ P 〉 0.05 ）, while after 8 week＇s treatment, patients in treatment group improved a lot on water swallow test, the standard of assessing degree of stroke neurological impairment on dysphagia subseale, Rosenbek aspiration level grading（ P 〈 0.05 ）. Treatment group＇s scores were [（ 2.03 ± 0.68 ）, （ 8.52 ± 1.66） and （2.55 ± 1.12） ] compared with the control group [（2. 55 ± 0.91 ）, （7.21± 2.29） and （ 3.55±1.82 ） ].It has significantly improvement and has statistically significant （ P 〈 0. 05 ） Conclusion Strengthening the training of respiratory function and normal swallowing function both can effectively improve the swallowing function in patients with stroke, and if increase training in respiratory function gonna be better.