说话瓣膜联合吞咽基础训练对重型颅脑损伤气管切开昏迷患者吞咽功能的影响

Effects of speech valve combined with basic swallowing training on aspiration of dysphagia patients after tracheostomy for severe traumatic brain injury

目的探讨说话瓣膜联合吞咽基础训练对重型颅脑损伤气管切开患者吞咽功能的疗效观察。方法将入选颅脑损伤患者30例按随机数字表法分为对照组(采用常规营养神经药物治疗及吞咽基础训练)和观察组(采用常规营养神经药物治疗及佩戴说话瓣膜吞咽康复训练),每组15例。观察组有1例因病情加重、1例因经济及家庭原因不能坚持治疗而退出研究,最后纳入统计的患者共28例,其中观察组15例,对照组13例。2组患者均接受吞咽基础训练,包括冰刺激、舌运动训练和咳嗽训练,观察组患者在吞咽训练的基础上,进行佩戴说话瓣膜训练,每日2次,每周5 d,共4周。分别于治疗前和治疗4周后(治疗后),采用才藤氏吞咽障碍评级和Rosenbek渗漏-误吸分级量表(PAS)评级对2组患者行喉镜吞咽功能检查及吞咽功能评估。结果治疗后,2组患者的才藤氏吞咽障碍等级和PAS评级均较组内治疗前明显改善(P<0.01),且观察组的改善程度明显优于对照组(P<0.05)。结论说话瓣膜联合吞咽基础训练可以改善重型颅脑损伤气管切开患者的吞咽功能,且减少其吞咽的误吸情况。

Objective To investigate the effectiveness of basic swallowing training for tracheotomy patients using a speech valve after severe cranial injury.Methods Thirty brain injury patients were randomly divided into a control group and an observation group,each of 15.In addition to conventional drug therapy,those in the control group were given basic swallowing training,while those in the observation group received the same swallowing training wearing a speech valve.The basic swallowing training included ice stimulation,tongue movement training and cough training twice a day,five days a week,for four weeks.The patients in the observation group were also trained to wear a speech valve on the same schedule.The subjects′swallowing function was evaluated laryngoscopically using Saito′s dysphagia rating scale and the Rosenbek leakage aspiration rating scale before and after the 4 weeks of treatment.Results Significant improvement was observed in both groups,with significantly greater improvement in the observation group,on average.Conclusions Basic swallowing training when wearing a speech valve can improve the swallowing function of patients with severe brain injury after a tracheotomy and reduce aspiration during swallowing.