低频脉冲治疗仪配合吞咽训练对脑卒中后吞咽障碍患者的影响

Effect of low-frequency pulse therapy instrument combined with swallowing training on swallowing function,cerebral blood flow and levels of serum BDNF and NGF in patients with dysphagia after stroke

目的探讨低频脉冲治疗仪配合吞咽训练对脑卒中后吞咽障碍患者吞咽功能、脑血流及血清脑源性神经营养因子(BDNF)、神经生长因子(NGF)水平的影响。方法纳入2018年4月~2021年4月于我院就诊的114例脑卒中后吞咽障碍患者作为研究对象,随机分为联合组(n=57)和对照组(n=57)。对照组予以常规治疗及进行吞咽训练,联合组在对照组基础上进行低频脉冲治疗仪治疗,比较治疗前及治疗1个月后两组患者洼田饮水实验(KDWT)]评级、功能性吞咽功能(功能性吞咽障碍量表FDS)评分、吞咽功能评分[标准吞咽功能评价量表(SSA)]、吞咽造影检查评分[吞咽X线荧光透视检查(VFSS)]及左右椎动脉和基底动脉脑血流、血清神经因子的差异。结果治疗1个月后,两组患者洼田饮水实验评级、功能性吞咽功能评分、吞咽功能评分、吞咽造影检查评分、血清神经因子水平(NGF、BDNF)较治疗前显著改善(P<0.05),且联合组改善显著高于对照组(P<0.05);治疗1个月后,两组患者双侧椎动脉和基底动脉平均血流速度(Vm)、收缩期血流速度(Vs)较治疗前显著提高(P<0.05),双侧椎动脉和基底动脉搏动指数(PI)较训练前显著降低(P<0.05),且联合组治疗后与对照组比较差异均有统计学意义(P<0.05)。结论低频脉冲治疗仪配合吞咽训练治疗脑卒中后吞咽障碍,可有效提高患者吞咽能力,改善其神经营养情况及脑部血流情况,降低不良结果的发生,值得临床借鉴。

Objective To observe the effect of low-frequency pulse therapy instrument combined with swallowing training on swallowing function,cerebral blood flow and levels of serum brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF)in patients with dysphagia after stroke.Methods A total of 114 patients with dysphagia after stroke who were treated in the hospital between April 2018 and April 2021 were selected as the research subjects,and they were randomly divided into combined group(n=57)and control group(n=57)according to the random number table method.Both groups received conventional treatment,and the control group received additional swallowing training,and the combined group was treated with low-frequency pulse therapy instrument on the basis of the control group.The Watian drinking water test rating,functional swallowing function score,swallowing imaging examination score,cerebral blood flow status of left and right vertebral arteries and basilar artery and serum nerve factors were compared between the two groups before treatment and after 1 month of treatment.Results After 1 month of treatment,the Watian drinking water test rating[Watian Drinking Water Test(KDWT)],functional swallowing score(Functional Dysphagia Scale FDS),swallowing function score[Standardized Swallowing Assessment(SSA)],swallowing imaging examination score[Videofluoroscopic Swallowing Study(VFSS)]and levels of serum nerve factors(NGF,BDNF)were significantly improved in the two groups of patients compared to before treatment(P<0.05),and the improvements in combined group were significantly higher than those in in control group(P<0.05).After 1 month of treatment,the mean blood flow velocity(Vm)and systolic blood flow velocity(Vs)of bilateral vertebral arteries and basilar artery in the two groups were significantly higher than those before treatment(P<0.05)while the pulsatility index(PI)of bilateral vertebral arteries and basilar artery was significantly lower than that before treatment(P<0.05),and the differences between combined group and control group after treatment were statistically significant(P<0.05).Conclusion Low-frequency pulse therapy instrument combined with swallowing training for the treatment of dysphagia after stroke can effectively enhance the swallowing ability,improve the neurotrophic status and cerebral blood flow,and reduce the occurrence of adverse Results,thus it is worthy of clinical promotion.