涤痰汤联合吞咽-摄食训练治疗脑卒中后吞咽障碍对患者舌骨喉活动度及血清GDF-15、S100β蛋白的影响

Effect of Ditan Decoction Combined with Swallowing and Ingesting Training on Movement of Hyoid-laryngeal Complex and Serum GDF-15 and S100βProtein Levels in Post-stroke Dysphagia Patients

【目的】探讨涤痰汤联合吞咽-摄食训练治疗脑卒中后吞咽障碍对患者舌骨喉活动度及血清生长分化因子15(GDF-15)、中枢神经特异蛋白S100β蛋白的影响。【方法】将116例脑卒中后吞咽障碍患者随机分为观察组和对照组,每组各58例。2组患者均给予调脂、控制血糖和血压、抗血小板及营养支持等常规治疗,在此基础上,对照组给予吞咽-摄食训练治疗,观察组给予涤痰汤联合吞咽-摄食训练治疗,疗程为1个月。观察2组患者治疗前后脑血流动力学[包括双侧大脑动脉血流最大峰值流速(Vs)、平均流速(Vm)、血管阻力指数(RI)]、舌骨喉复合体活动度、神经功能缺损程度量表(NDF)评分及血清GDF-15、S100β蛋白水平的变化情况,并评价2组患者的吞咽功能改善疗效。【结果】(1)治疗1个月后,观察组的总有效率为87.93%(51/58),对照组为68.97%(40/58),组间比较,观察组的吞咽功能改善疗效明显优于对照组(P<0.05)。(2)治疗后,观察组的舌骨上移和舌骨前移活动度均较治疗前明显改善(P<0.01),而对照组治疗前后均无明显变化(P>0.05),组间比较,观察组对舌骨上移和舌骨前移活动度的改善作用明显优于对照组(P<0.01);在甲状软骨活动度方面,2组治疗前后及组间比较,差异均无统计学意义(P>0.05)。(3)治疗后,2组患者血清GDF-15水平均较治疗前明显降低(P<0.01),血清S100β蛋白水平均较治疗前明显升高(P<0.01),且观察组对血清GDF-15水平的降低作用和对血清S100β蛋白水平的升高作用均明显优于对照组(P<0.01)。(4)治疗后,2组患者的Vs、Vm水平均较治疗前明显升高(P<0.01),RI水平均较治疗前明显降低(P<0.01),且观察组对Vs、Vm水平的升高作用和对RI水平的降低作用均明显优于对照组(P<0.01)。(5)治疗后,2组患者NDF各项评分及总分均较治疗前明显降低(P<0.01),且观察组对NDF各项评分及总分的降低作用均明显优于对照组(P<0.05)。【结论】涤痰汤联合吞咽-摄食训练治疗脑卒中后吞咽障碍患者,可有效改善其吞咽功能和舌骨喉活动情况,促进脑血流动力学的改善,降低血清GDF-15水平,提高血清S100β蛋白水平,进而促进患者神经功能恢复。

Objective To investigate the effect of Ditan Decoction combined with swallowing and ingesting training on the movement of hyoid-laryngeal complex and serum levels of growth differentiation factor-15(GDF-15)and central nervous specific protein S100β in post-stroke dysphagia patients. Methods A total of 116 patients with post-stroke dysphagia were randomly divided into observation group and control group,58 patients in each group.Patients in the two groups were given routine treatment of lowering lipid,controlling blood glucose control and blood pressure, antiplatelet therapy and nutritional support. And additionally, the control group was given swallowing and ingesting training,and the observation group was given Ditan Decoction combined swallowing and ingesting training, the course of treatment lasting one month. The changes in cerebral hemodynamics of peak velocity(Vs),mean velocity(Vm)and resistance index(RI)of bilateral cerebral arteries,the velocity of hyoidlaryngeal complex,neurological functional deficit scale(NFD)scores,and serum GDF-15 and S100β protein levels in the two groups were observed before and after treatment. Meanwhile,the effect on improving swallowing function in the two groups was also evaluated. Results(1)After one month of treatment,the total effective rate in the observation group was 87.93%(51/58),and that in the control group was 68.97%(40/58). The intergroup comparison showed that the improvement of swallowing function in the observation group was significantly superior to that in the control group(P< 0.05).(2)After treatment,the range of motion of hyoid upward movement and hyoid forward movement in the observation group was significantly improved compared with that before treatment(P< 0.01),but the control group showed no obvious changes before and after treatment(P > 0.05). The intergroup comparison showed that the improvement of the hyoid upward movement and hyoid forward movement in the observation group was superior to that in the control group(P< 0.01). There was no significant difference in thyroid cartilage movement between the two groups and before and after treatment(P > 0.05).(3)After treatment,the serum GDF-15 level in the two groups was significantly lower and the serum S100β protein level in the two groups was significantly higher than those before treatment(P< 0.01),and the effect on decreasing GDF-15 and on increasing S100β protein in the observation group was stronger than that in the control group(P<0.01).(4)After treatment,the peak velocity(Vs)and mean velocity(Vm)of blood flow of bilateral cerebral arteries in the two groups were significantly increased and the level of resistance index(RI)in the two groups was significantly decreased compared with those before treatment(P< 0.01),and the effects on increasing Vs and Vm and on decreasing RI level in the observation group were stronger than those in the control group(P< 0.01).(5)After treatment, the NFD dimension scores and overall scores in the two groups were significantly lower than those before treatment(P< 0.01),and the effect on decreasing the NFD dimension scores and overall scores in the observation group was stronger than that in the control group(P< 0.05). Conclusion In the treatment of patients with post-stroke dysphagia, Ditan Decoction combined with swallowing and ingesting training can effectively improve the swallowing function and the movement of hyoid-laryngeal complex,improve cerebral hemodynamics,reduce the serum GDF-15 level, increase the serum S100β protein level, so as to promote the recovery of neurological function.