呼吸训练对脑瘫患儿吞咽障碍的干预效果分析

Effect of Respiratory Training on Dysphagia in Children with Cerebral Palsy

目的:观察呼吸训练对脑瘫患儿吞咽障碍的干预效果。方法:将最终符合条件的96例伴有吞咽障碍的脑瘫患儿按照随机数字表法分为观察组和对照组各48例。2组均采用基础康复训练,观察组在此基础上加用呼吸训练,30 min/次,1次/d,5 d/周,3个月为1个疗程。分别在治疗前后采用吞咽功能调查表(DDS)评定2组患儿吞咽障碍程度及分级,根据藤岛一郎吞咽障碍评定标准评估2组疗效。结果:2组治疗前DDS评分和吞咽障碍程度分级比较,差异均无统计学意义(P>0.05)。治疗3个月后DDS评分显示,2组各项指标与治疗前比较,改善具有统计学意义(P<0.05);观察组治疗后的DDS总分、口腔期、咽期分数分别为(5.33±3.08)、(4.63±2.23)、(0.70±0.78)分,优于对照组的(7.20±3.43)、(5.58±2.13)、(1.81±1.38)分,差异均有统计学意义(P<0.05);观察组食管期DDS分数为(0.06±0.24)分,对照组(0.08±0.28)分,差异无统计学意义(P>0.05)。2组治疗前后不同分型脑瘫儿童DDS评分比较,痉挛型四肢瘫、不随意运动型、混合型脑瘫患儿DDS总分与治疗前比较,改善均有统计学意义(P<0.05);2组间比较,观察组痉挛型四肢瘫(6.58±2.47)分、不随意运动型(4.57±2.10)分、混合型(4.57±2.59)分,均优于对照组的(8.78±3.30)、(6.41±2.35)、(7.47±3.18)分,差异均有统计学意义(P<0.05);共济失调型、痉挛型偏瘫脑瘫患儿样本量小,无统计学意义(P>0.05)。2组治疗前后吞咽障碍程度分级均得到改善,且观察组较对照组改善明显(P<0.05)。2组疗效比较,观察组总有效率(87.50%)优于对照组(70.83%),差异有统计学意义(P<0.05)。结论:呼吸训练配合基础吞咽训练能够明显改善脑瘫患儿的吞咽障碍症状。

Objective: To observe the effect of respiratory training on dysphagia in children with cerebral palsy. Methods: A total of 96 eligible children with cerebral palsy accompanied by dysphagia were divided into observation group and control group according to the random number table method, with 48 cases in each group. The basic rehabilitation training was used in both groups. And the observation group was given breathing training in addition, 30 minutes per time, once a day, 5 days per week, 3 months as a course of treatment. The degree and grade of dysphagia were assessed by DDS before and after treatment, and the curative effect was assessed by Fujima Ichiro’s dysphagia evaluation criteria before and after treatment. Results: There was no significant difference in DDS scores and dysphagia grade between the two groups before treatment(P>0.05). After three months of treatment, the DDS scores of two groups showed significant improvement compared with those before treatment(P<0.05). The total scores of DDS, oral and pharyngeal stages in the observation group were(5.33±3.08),(4.63±2.23),(0.70±0.78) respectively, which were better than those in the control group(7.20±3.43),(5.58±2.13),(1.81±1.38). The differences were statistically significant(P<0.05). The DDS score in oesophagus stage of the observation group was(0.06±0.24) and that of the control group was(0.08±0.28). There was no significant difference between the two groups(P>0.05). The DDS scores of children with spastic quadriplegia, involuntary motor type and mixed cerebral palsy before and after treatment in the two groups were significantly improved compared with those before treatment(P<0.05).The DDS scores of children with spastic quadriplegia, involuntary motor type and mixed cerebral palsy in the observation group(6.58±2.47),(4.57±2.10) and(4.57±2.59) were better than those in the control group(8.78±3.30),(6.41±2.35),(7.47±3.18), and there were significant differences between the two groups(P<0.05). There was no significant difference in the sample size of ataxia and spastic hemiplegia children(P>0.05). The degree of dysphagia was improved in the two groups before and after treatment, and the improvement in the observation group was more obvious than that in the control group(P<0.05). The total effective rate of the observation group(87.50%) was better than that of the control group(70.83%), and the difference was statistically significant(P<0.05).Conclusion: Respiratory training combined with basic swallowing training can significantly improve the symptoms of dysphagia in children with cerebral palsy.