涤痰汤加减联合表面肌电生物反馈对脑梗死后吞咽障碍患者吞咽功能的效应观察

Effect of Modified Ditan Decoction Combined with Surface Electromyography Biofeedback on Swallowing Function in Patients with Dysphagia after Cerebral Infarction

目的:观察涤痰汤加减联合表面肌电生物反馈对脑梗死后吞咽障碍患者吞咽功能的效应,探讨该治疗方案的利弊,为临床脑梗死吞咽障碍患者提供新的治疗方案。方法:选取2016年10月至2017年12月在延安大学咸阳医院治疗的符合纳入条件的脑梗死后吞咽障碍患者110例作为研究对象,随机分为对照组和观察组,每组55例。2组患者均给予脑梗死常规治疗(抗血小板、调脂、控血压、血糖等措施)及表面肌电生物反馈仪治疗,观察组在对照组治疗基础上,对患者行中医辨证,并以涤痰汤为基础方加减辨治。2组患者均以2周为1个疗程,连续治疗2个疗程。分别于治疗前后对患者的摄食功能(FOIS)评分、饮水功能(蛙田饮水评级)、脑卒中临床神经功能缺损程度量表(NDF)、吞咽障碍特异性生命质量量表(SWAL-QOL)进行测评,采用藤岛一郎吞咽疗效评价标准判断2组治疗前后吞咽障碍临床疗效,并分别进行治疗前后组内及治疗后组间比较;比较2组患者治疗过程中药物不良反应发生率。结果:1)治疗2个疗程后,2组患者FOIS评分均较治疗前明显提升(P<0.05),且观察组明显低于对照组(P<0.05)。2)2组患者治疗后蛙田饮水评级较治疗前均明显下降,且观察组明显低于对照组(P<0.05)。3)2组患者治疗后NDF评分均较治疗前明显降低(P<0.05),且观察组低于对照组(P<0.05)。4)2组患者治疗后,观察组吞咽障碍临床总有效率显著高于对照组(P<0.05)。5)2组患者治疗后SWAL-QOL评分均较治疗前明显提升(P<0.05),且观察组明显高于对照组(P<0.05)。6)2组患者治疗过程中药物不良反应率比较,差异无统计学意义(P>0.05)。结论:涤痰汤加减联合表面肌电生物反馈治疗脑梗死后吞咽功能障碍,可显著增强患者吞咽功能效应,明显提高患者的生命质量,且安全性高,可作为脑梗死后吞咽功能障碍的良好治疗方案。

Objective:To observe the effects of modified Ditan Decoction combined with surface electromyography biofeedback on swallowing function in patients with dysphagia after cerebral infarction,and to explore the advantages and disadvantages of this treatment scheme,so as to provide a new treatment option for patients with dysphagia after cerebral infarction.Methods:A total of 110 patients with dysphagia after cerebral infarction who met the inclusion criteria from October 2016 to December 2017 were randomly divided into a control group and a treatment group,with 55 cases in each group.Patients in both groups were given routine treatment of cerebral infarction(anti-platelet,lipid regulation,blood pressure control,blood sugar and other measures)and surface electromyogram biologic hair silk instrument treatment,2 weeks for a course of treatment.On the basis of the treatment of the control group,the patients in the treatment group were treated with TCM syndrome differentiation,and on the basis of Ditan Decoction,with modification treatment,2 weeks as a course of treatment.Two groups of patients were treated continuously for 2 courses.The patients′feeding function(FIOS),drinking function(Randa drinking water rating),stroke clinical neurological deficit scale(NDF),swallowing disorder specific quality of life(SWAL-QOL)were assessed and compared before and after treatment.Fujima Yilang swallowing efficacy evaluation criteria was used to judge and compare the clinical efficacy of dysphagia in 2 groups of patients before and after treatment.The adverse drug reaction rates of the 2 groups before and after treatment were compared.Results:1)After 2 courses of treatment,the FIOS scores of the 2 groups were significantly increased than those before treatment,and the FIOS scores of the treatment group were significantly lower than those of the control group(P<0.05).2)After treatment,the drinking water rating of the 2 groups was significantly decreased than that before treatment,and the treatment group was significantly lower than that of the control group(P<0.05).3)After treatment,NDF scores of the 2 groups were significantly decreased than those before treatment,and the treatment group was lower than that of the control group(P>0.05).4)After treatment,the total effective rate of the treatment group was significantly higher than that of the control group(P<0.05).5)After treatment,SWAL-QOL scores of the 2 groups were significantly increased than before treatment,and the treatment group was significantly higher than the control group(P<0.05).6)There was no significant difference in the adverse drug reaction rate between the 2 groups(P>0.05).Conclusion:Modified Ditan Decoction combined with surface electromyography can significantly enhance the swallowing function of patients with dysphagia after cerebral infarction,and significantly improve the quality of life of patients with high safety,and can be used as a good treatment option for patients with dysphagia after cerebral infarction.