经口间歇管饲联合自拟宣窍利咽汤治疗脑卒中后吞咽障碍的临床疗效

Clinical effects of intermittent oro-esophageal tube feeding combined with Xuanqiaoliyan decotion in stroke patients with dysphagia

目的观察经口间歇管饲(IOE)联合宣窍利咽汤治疗脑卒中后吞咽障碍的临床疗效。方法采用前瞻性研究方法,选择2018年1月至2019年12月潍坊医学院附属益都中心医院收治的脑卒中后吞咽障碍患者。按照简单随机法将患者分为对照组和观察组,每组50例。对照组采用常规吞咽功能训练,包括低频脉冲电刺激、吞咽功能训练及针灸治疗;观察组在对照组基础上加用IOE及自拟宣窍利咽汤加减治疗(方药组成:石菖蒲15 g,远志10 g,天麻15 g,胆南星6 g,白附子6 g,全蝎6 g,僵蚕6 g,苏子10 g,姜半夏10 g,陈皮10 g,生姜3片,水煎服200 mL,早晚分2次服用或鼻饲);两组疗程均为14 d。治疗前后采用标准吞咽功能评定法(SSA)及洼田饮水试验评估患者吞咽功能。观察两组患者吞咽功能改善时间、总住院时间、治疗效果,并进行安全性评估。结果两组患者性别、年龄、病程、脑卒中位置和卒中次数比较差异均无统计学意义,具有可比性。两组治疗后SSA评分均有降低,洼田饮水试验分级有所改善,且观察组SSA评分显著低于对照组(分:19.8±1.8比23.2±3.2,P<0.05),洼田饮水试验恢复程度优于对照组〔完全恢复(例):18比13,基本恢复(例):23比18,有效(例):9比19,χ^(2)=-2.107,P=0.008〕。观察组治疗总有效率显著高于对照组(94.0%比80.0%,Z=4.684,P=0.012),吞咽功能改善时间(d:12.8±2.6比16.9±4.3,t=11.628,P=0.008)和总住院时间(d:20.8±4.2比33.5±5.6,t=10.924,P=0.015)均较对照组明显缩短。观察组IOE操作过程中出现咽喉部不适症状1例,操作结束后症状即消失;丙氨酸转氨酶(ALT)、血尿素氮(BUN)轻度升高各1例,治疗结束后复查肝肾功能各指标均恢复正常。对照组患者无不良症状及肝肾功能受损事件出现。结论IOE联合宣窍利咽汤能够显著改善脑卒中后吞咽障碍患者的吞咽功能,缩短住院时间,提高治疗疗效及生活质量。

Objective To investigate the clinical effects of intermittent oro-esophageal tube feeding(IOE)combined with Xuanqiaoliyan decotion in stroke patients with dysphagia.Methods A prospective study was conducted.Stroke patients with dysphagia admitted to Yidu Central Hospital Affiliated Hospital of Weifang Medical University from January 2018 to December 2019 were enrolled.According to the simple random sampling method,the patients were divided into control group and observation group,with 50 cases in each group.The control group was given routine swallowing function training,including low-frequency pulse electrical stimulation,swallowing function training and acupuncture treatment.The observation group was given IOE and Xuanqiaoliyan decoction(prescription composition:Rhizoma acori tatarinowii 15 g,Radix polygalae 10 g,Rhizoma gastrodiae 15 g,Arisaema cum bile 6 g,Rhizoma typhonii 6 g,Scorpio 6 g,Bombyx batryticatus 6 g,Perilla frutescens 10 g,Rhizoma pinelliae 10 g,Pericarpium citri reticulatae 10 g,Rhizoma zingiberis recens 3 tablets,decoction 200 mL,twice in the morning and evening by oral or nasal feeding)on the basis of the control group.Both groups were treated for 14 days.The standard swallowing function assessment(SSA)and water swallow test were used to evaluate the swallowing function before and after treatment.The time required for the improvement of swallowing function,total hospitalization time and the therapeutic effects were observed and the safety assessment was conducted.Results There were no significant differences in the gender,age,course of disease,and location and frequency of stroke between the two groups.After treatment,both the SSA scores in the two groups were decreased,and the grading of water swallow test was improved.The SSA scores in the observation group were significantly lower than that in the control group(19.8±1.8 vs.23.2±3.2,P<0.05),the recovery degree of water swallow test was higher than that in the control group[complete recovery(cases):18 vs.13,basic recovery(cases):23 vs.18,effective(cases):9 vs.19,χ^(2)=-2.107,P=0.008].The total effective rate of swallowing function in the observation group was higher than that in the control group(94.0%vs.80.0%,Z=4.684,P=0.012),the time for improvement(days:12.8±2.6 vs.16.9±4.3,t=11.628,P=0.008)and total hospitalization time(days:20.8±4.2 vs.33.5±5.6,t=10.924,P=0.015)were shorter than those in the control group.In the observation group,there was 1 case of throat discomfort during the operation of IOE,and the symptoms disappeared after the operation;there was 1 case of mild elevation of alanine aminotransferase(ALT)and blood urea nitrogen(BUN)respectively,which returned to normal after the treatment.No adverse symptoms and damage to the liver and kidney were observed in the control group.Conclusion IOE combined with Xuanqiaoliyan decotion could significantly improve the swallowing function of stroke patients with dysphagia,shorten the hospitalization time,and improve the curative effects and lifequality.