体外膈肌起搏器联合吞咽功能训练对脑卒中后吞咽障碍改善的作用观察

Effect of external diaphragm pacemaker combined with swallowing function training on improvement of dysphagia after stroke

目的观察体外膈肌起搏器(EDP)联合吞咽功能训练对脑卒中后吞咽障碍改善的作用。方法将2017-04~2020-05该院80例脑卒中后吞咽障碍患者按随机数字表法分为观察组和对照组,每组40例,中途退出4例,最终纳入统计为76例,对照组39例,观察组37例。对照组给予吞咽功能基础训练,观察组在吞咽功能基础训练的基础上联合应用EDP进行治疗。治疗前与治疗4周后,使用标准吞咽功能评定量表(SSA)和中文版吞咽生存质量量表(SWAL-QOL)评估两组患者吞咽功能和生存质量,比较两组观察期肺炎的发生率。结果治疗4周后,两组患者的SSA评分较治疗前降低(P<0.01),SWAL-QOL评分较治疗前提高(P<0.01),且观察组优于对照组(P<0.05);观察组肺炎发生率为8.1%,低于对照组的33.3%(P<0.05)。结论EDP联合吞咽功能基础训练可明显改善脑卒中后患者吞咽功能,降低肺炎发生率,改善生存质量,且效果优于单纯进行吞咽功能基础训练,值得推广。

Objective To observe the effect of external diaphragm pacemaker(EDP)combined with swallowing function training on improvement of dysphagia after stroke.Methods Eighty patients with dysphagia after stroke in the Third Affiliated Hospital of Sun Yat-sen University,Yuedong Hospital from April 2017 to May 2020 were divided into the observation group and the control group by random number table method,with 40 cases in each group,among whom 4 cases dropped out,and 76 cases were finally included for the statistics,including 39 cases in the control group and 37 cases in the observation group.The control group was given basic training of swallowing function,and the observation group was treated with EDP on the basis of basic training of swallowing function.The patients in both groups were evaluated for the swallowing function and the quality of life by Standardized Swallowing Assessment(SSA)and Chinese Swallowing Quality of Life Questionnaire(SWAL-QOL)before and 4 weeks after treatment.The incidence of pneumonia during the observation period was compared between the two groups.Results After 4 weeks of treatment,the SSA scores of the patients in both groups were significantly lower than those before treatment(P<0.01),while the SWAL-QOL scores were significantly higher than those before treatment(P<0.01),and the observation group was better than the control group(P<0.05).The incidence of pneumonia in the observation group(8.1%)was significantly lower than that in the control group(33.3%)(P<0.05).Conclusion EDP combined with swallowing function basic training can significantly improve the swallowing function of stroke patients,reduce the incidence of pneumonia,improve the quality of life,and the effect of the combined treatment is better than that of the simple swallowing function basic training,and the combined treatment is worthy of clinical promotion.