多感觉刺激联合镜像疗法在脑卒中吞咽障碍患者中的应用研究

Application of Multi-Sensory Stimulation Combined with Mirror Therapy in Stroke Patients with Dysphagia

目的探讨多感觉刺激技术联合镜像疗法对脑卒中吞咽障碍患者的康复效果。方法选取脑卒中合并吞咽障碍患者58例,按随机数字表法分成对照组28例和试验组30例。对照组按照常规吞咽障碍康复护理,试验组在对照组的基础上开展多感觉刺激技术联合镜像疗法,治疗4周。观察治疗前后间接评估口腔情况(包括流涎,唾液、食物残留,声嘶,闭唇对称,伸舌居中)、误吸风险(根据SSA评分结果初步判断患者的吞咽功能,并按照吞咽功能的不同等级对患者进行误吸风险等级的划分)、反复唾液吞咽次数(采用反复唾液试验),评介吞咽功能疗效(采用才藤吞咽障碍7级评价法)和口腔卫生状况(采用改良版Beck口腔评分表)。结果治疗4周后试验组间接评估口腔情况、误吸风险等级、反复唾液吞咽次数和口腔卫生状况改善情况均优于对照组(均P<0.05);试验组吞咽功能总有效率为86.67%,高于对照组的64.30%(P<0.05)。结论实施多感觉刺激联合镜像疗法可有效促进脑卒中患者吞咽康复。

Objective To explore the effect of multi-sensory stimulation combined with mirror therapy on rehabilitation of stroke patients with dysphagia.Methods Fifty-eight patients with stroke and swallowing disorders were randomly given routine rehabilitation nursing alone(control group,28 patients)or in combination with multi-sensory stimulation and mirror therapy(experimental group,30 patients)for 4 weeks.Salivation,saliva,food residue,hoarseness,symmetrical lip closing and tongue protruding toward the middle were observed to evaluate the oral condition.The swallowing function was preliminarily determined using the SSA score,and the risk of mis-aspiration was classified according to the swallowing function.The repetitive saliva swallowing times were measured using the repetitive saliva swallowing test(RSST).The curative effect was assessed by the 7-grade dysphagia evaluation method.The oral hygiene status was examined by the modified Beck oral rating scale.Results After 4 weeks of treatment,compared with the control group,oral condition,mis-aspiration risk level,repetitive saliva swallowing times and oral hygiene were significantly improved in the experimental group(P<0.05).Furthermore,the total swallowing efficiency in the experimental group(86.67%)was higher than that in the control group(64.30%)(P<0.05).Conclusion Multi-sensory stimulation combined with mirror therapy can effectively promote swallowing rehabilitation in stroke patients.