经穴推拿联合吞咽康复训练对老年脑卒中后吞咽障碍患者的影响

Effect of Meridian Massage combined with Swallowing Rehabilitation Training on Elderly Patients with Dysphagia after Stroke

目的:观察经穴推拿联合吞咽康复训练对老年脑卒中合并吞咽障碍患者的影响。方法:选择2019年3月—2020年6月在南京中医药大学附属医院老年医学科治疗的老年脑卒中合并吞咽障碍患者65例,采用随机数字表法分为对照组和观察组,分别为33例和32例。对照组在脑卒中常规治疗和早期康复锻炼基础上给予常规吞咽功能康复训练,主要包括吞咽器官训练、冰刺激、咳嗽与呼吸训练及摄食管理,1次/d,6 d/周,共持续训练4周,出院后随访12周。观察组在对照组基础上联合采用经穴推拿治疗。患者取端坐位,全身放松,操作者依次以点法、揉法和推法相结合的手法进行经穴推拿治疗。先按揉双侧风池穴、翳风穴2 min;接着以手指推揉患者面颊部的地仓穴至颊车穴3 min,再推揉任脉上的承浆穴至廉泉穴2 min;最后将食指、中指放置于舌骨处,向上向后持续按压数秒。治疗过程中要求操作者手法轻柔,逐渐用力,由轻至重,反复推拿使患者感到局部"酸痛"为宜,以不引起患侧肌肉痉挛、健侧肌肉过度收缩为度。1次/d,6 d/周,共持续治疗4周。出院后由家属或陪护者进行经穴推拿,定期安排复诊,并进行12周的随访。分别于治疗前、治疗4周后、随访12周时采用GUSS吞咽功能评价量表对患者进行吞咽功能评定;采用Barthel指数评定量表评估患者的日常生活活动能力。比较2组误吸发生率、吸入性肺炎发生率、胃管成功拔除率与胃管留置时间的区别。结果:治疗前,2组GUSS吞咽功能评分和Barthel评分比较,差异无统计学意义(P>0.05)。与对照组比较,观察组治疗4周后、随访12周后GUSS评分、Barthel评分均明显提高,差异具有统计学意义(P<0.05)。与对照组比较,观察组治疗4周后胃管成功拔除率明显更高,胃管留置时间明显缩短,差异具有统计学意义(P<0.05)。2组误吸发生率、吸入性肺炎发生率比较,差异无统计学意义(P>0.05)。结论:经穴推拿联合吞咽康复训练可有效提高胃管拔除成功率,缩短胃管留置时间,改善老年脑卒中后合并吞咽障碍患者吞咽功能和日常生活活动能力。

Objective:To observe the effect of meridian massage combined with swallowing rehabilitation training on elderly patients with dysphagia after stroke.Methods:A total of 65 elderly patients with dysphagia after stroke who were treated in the department of geriatrics of the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2019 to June 2020,which were randomly divided into the control group and the observation group,with 33 cases and 32 cases in each group respectively.The control group was given routine swallowing rehabilitation training on the basis of routine treatment and early rehabilitation exercise,mainly including swallowing organ training,ice stimulation,cough and breathing training and feeding management,once a day,six days a week,continous training for four weeks,followed up for 12 weeks after discharge.The observation group was treated with meridian massage on the basis of the control group.The patients took the sitting position and relaxed the whole body,which were treated with meridian massage by combining the point-pressing manipulation,kneading manipulation and pushing manipulation in turn.Firstly,the bilateral Fengchi acupoints and Yifeng acupoints were massaged for two minutes;then,the patient's cheek was pushed and knead with his fingers from Dicang acupoint to Jiache acupoint for three minutes,and then pushed and kneaded the Chengjiang acupoint to Lianquan acupoint on Conception Vessel for two minutes;Finally,the index finger and middle finger were placed on the hyoid bone,which was pressed towards the up and back for a few seconds.During treatment,the operator was required to use gentle manipulation,gradually exerting force,from light to heavy,repeated massage should make the patient feel local"pain",so as not to cause muscle spasm on the affected side and excessive contraction of the healthy side,one time a day,six days a week,continous treatment for four weeks.The patients were given meridian massage by the family members or caregivers after discharge,and the patients were followed up for 12 weeks.Before treatment,four weeks after treatment and 12 weeks after follow-up,the Gugging swallowing screen(GUSS)was used to assess the swallowing function;the Barthel index scale was used to evaluate the activities of daily living;the incidence of aspiration and aspiration pneumonia,successful removal rate of gastric tube and indwelling time of gastric tube were compared between the two groups.Results:Before treatment,there was no significant difference in GUSS score and Barthel score between the two groups(P>0.05).Compared with the control group,the GUSS score and Barthel score of the observation group after treatment for four weeks and follow-up for 12 weeks were significantly improved,and the difference was statistically significant(P<0.05).Compared with the control group,the success rate of gastric tube removal in the observation group after treatment for four weeks was significantly higher and the indwelling time of gastric tube was significantly shorter,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of aspiration and aspiration pneumonia between the two groups(P>0.05).Conclusion:Meridian massage combined with swallowing rehabilitation training can effectively improve the success rate of gastric tube removal,shorten the indwelling time of gastric tube,and improve the swallowing function and activities of daily living of elderly patients with dysphagia after stroke.