吞咽训练对颈椎前路减压椎间融合术后吞咽困难患者的影响

Effect of swallowing training on dysphagia patients after anterior cervical decompression and interbody fusion

目的探讨吞咽训练对颈椎前路减压椎间融合术后吞咽困难患者的影响。方法选择2014年1月至2018年1月哈尔滨医科大学附属第二医院骨外科施行颈椎前路减压椎间融合术且存在吞咽困难的患者119例,按照随机数字表法分为干预组59例和对照组60例。对照组患者给予医院常规护理及健康教育,干预组患者在此基础上给予6个月的吞咽训练,分别采用洼田饮水试验和安德森吞咽困难生命质量量表(MDADI)评估2组患者吞咽功能和生命质量并比较。结果2组患者干预前吞咽功能和生命质量比较差异无统计学意义(P>0.05)。干预组患者干预后的洼田饮水试验评分为2.00(1.00,3.00)分,低于对照组的3.00(2.00,4.00)分,差异有统计学意义(Z值为3.205,P<0.01)。干预组患者干预后的MDADI总分及总体、情绪、社会功能和生理功能4个维度评分分别为(69.91±10.59)、(3.37±0.63)、(21.37±2.97)、(17.91±2.14)、(27.26±4.19)分,均高于对照组的(64.61±9.78)、(2.96±0.66)、(19.69±3.03)、(16.48±2.06)、(25.48±4.41)分,差异有统计学意义(t值为2.257~3.714,均P<0.05)。结论吞咽训练可以提高患者口腔、舌部、颊部、下颌及咽喉肌群活动范围与力量,有助于改善患者吞咽困难状况和生命质量。

Objective To explore the effect of swallowing function training on dysphagia patients after anterior cervical decompression and interbody fusion.Methods From January 2014 to January 2018,119 patients with anterior cervical decompression and interbody fusion and difficulty in swallowing were divided into intervention group(59 cases)and control group(60 cases)by random digits table method.Patients in the control group were given routine hospital nursing and health education,while patients in the intervention group were given swallowing function training for 6 months,and swallowing function and quality of life were evaluated by Water Swallow Test and M.D.Anderson Dysphagia Inventory(MDADI)and compared between the two groups.Results There was no significant difference in swallowing function and quality of life between the two groups(P>0.05).After intervention,Water Swallow Test score was 2.00(1.00,3.00)in the intervention group,and 3.00(2.00,4.00)in the control group,the difference was statistically significant(Z value was 3.205,P<0.01).After intervention,the total score of MDADI and general,emotional,social and physiological functions dimensions was(69.91±10.59),(3.37±0.63),(21.37±2.97),(17.91±2.14),(27.26±4.19)in the intervention group,and(64.61±9.78),(2.96±0.66),(19.69±3.03),(16.48±4.41)in the control group,the difference was statistically significant(t value was 2.257-3.714,all P<0.05).Conclusions Swallowing function training can improve the range and strength of patients'oral,tongue,cheek,mandible and pharynx and larynx muscles,and help improve patients'dysphagia and quality of life.