综合性康复训练治疗神经源性吞咽障碍的临床效果

Clinical Effect of Comprehensive Rehabilitation Training on Neurogenic Dysphagia

目的运用不同评估方法探讨综合性康复训练对神经源性吞咽障碍的治疗效果。方法 选取神经源性吞咽障碍患者72例,其中脑梗死28例,脑出血27例,其他17例。通过综合性康复训练(口腔感觉训练、口腔运动训练、针灸治疗及Vitalstim吞咽治疗)治疗2周,分别于治疗前后应用反复唾液试验、洼田饮水试验、标准吞咽功能评估(SSA)、电视透视吞咽检查(VFSS)检测患者吞咽功能,观察综合性康复训练对神经源性吞咽障碍患者的治疗效果。结果 与治疗前相比,患者治疗后反复唾液试验吞咽次数、洼田饮水试验评分及VFSS评分均显著升高(均 P <0.05),SSA评分显著降低( P <0.05)。脑出血洼田饮水试验治疗有效率较脑梗死显著升高( P <0.05),其余评估方法脑出血与脑梗死治疗有效率比较差异均无统计学意义( P >0.05)。结论 吞咽功能训练结合传统康复治疗、Vitalstim吞咽治疗仪训练对改善神经源性吞咽障碍患者的吞咽功能能取得较好的治疗效果,且观察发现在脑卒中合并吞咽障碍患者中脑出血吞咽障碍预后较脑梗死更好。

Objective To investigate the therapeutic effect of comprehensive rehabilitation training on neurogenic dysphagia using different evaluation methods. Methods Seventy-two patients with neurogenic dysphagia(28 patients with cerebral infarction,27 patients with cerebral hemorrhage and 17 patients with other diseases) were given comprehensive rehabilitation training(oral sensation training,oral movement training,acupuncture and Vitalstim therapy) for 2 weeks.The swallowing function was evaluated by repetitive saliva swallowing test(RSST),water swallowing test(WST),standardized swallowing assessment(SSA) and videofluoroscopic swallowing study(VFSS) before and after treatment. Results The swallowing frequency in RSST,WST score and VFSS score increased but SSA score decreased after treatment( P <0.05).The WST showed that the effective rate of comprehensive rehabilitation training for cerebral hemorrhage is higher than that for cerebral infarction( P <0.05).However,the RSST,SSA and VFSS showed that there were no significant differences in the therapeutic efficiency between patients with cerebral hemorrhage and patients with cerebral infarction( P >0.05). Conclusion Swallowing training combined with traditional rehabilitation and Vitalstim therapy can effectively improve the swallowing function in patients with neurogenic dysphagia.Furthermore,the combined treatment for cerebral hemorrhage leads to a better prognosis than that for cerebral infarction in stroke patients with dysphagia.