舌肌训练联合吞咽功能训练在脑卒中后吞咽障碍患者中的应用

Application of tongue muscle training combined with swallowing function training in patients with dysphagia after stroke

目的探讨舌肌训练联合吞咽功能训练在脑卒中后吞咽障碍患者中的应用。方法选择2018年1月~2020年7月于浙江省台州医院神经科治疗的脑卒中后吞咽障碍患者126例,采用抛硬币法均分为对照组和联合组,每组各63例。对照组予吞咽功能训练,联合组在对照组基础上加舌肌训练治疗,两组均治疗8周。比较两组治疗前与治疗8周后的标准吞咽功能评价量表(SSA)评分、电视透视吞咽功能检查(VFSS)评分和洼田饮水试验评分变化,并比较其临床疗效。结果治疗8周后,对照组和联合组的SSA评分[(27.92±4.08)分、(23.18±3.27)分]较治疗前[(35.45±5.16)分、(34.96±5.78)分]明显下降,VFSS评分[(5.72±0.91)分、(6.78±1.04)分]和洼田饮水试验评分[(3.52±0.73)分、(3.97±0.70)分]较治疗前[(4.48±0.67)分、(4.52±0.71)分、(2.95±0.56)分、(3.02±0.59)分]明显上升(P<0.05或P<0.01),且治疗后联合组的SSA评分低于对照组,VFSS评分和洼田饮水试验评分高于对照组(P<0.05);同时联合组的临床总有效率(95.24%)明显高于对照组(84.13%),差异有统计学意义(χ^(2)=4.201,P<0.05)。结论舌肌训练联合吞咽功能训练治疗脑卒中后吞咽障碍患者的疗效肯定,能明显减轻吞咽障碍程度,改善吞咽功能,使患者日常的摄食逐渐恢复正常。

Objective To explore the application of tongue muscle training combined with swallowing function training in patients with dysphagia after stroke.Methods A total of 126 patients with dysphagia after stroke treated in the Department of Neurology of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University from January 2018 to July 2020 were selected.The coin tossing was adopted to divide them into two groups with 63 cases in each group.The control group received swallowing function training,and the combination group received tongue muscle training on the basis of the treatment of the control group.Both groups were treated for 8 weeks.The changes in the standardized swallowing assessment(SSA)score,the video-fluoroscopic swallowing study(VFSS)score and the Kubota drinking water test score were compared between the two groups before treatment and after 8 weeks of treatment,and their clinical efficacy was compared.Results After 8 weeks of treatment,the SSA score of the control group and the combination group[(27.92±4.08)points,(23.18±3.27)points]was significantly lower than that of two groups before treatment[(35.45±5.16)points,(34.96±5.78)points];the VFSS score[(5.72±0.91)points,(6.78±1.04)points]and the scores of the Kubota drinking water test[(3.52±0.73)points,(3.97±0.70)points]were significantly higher than those of two groups before treatment(P<0.05 or P<0.01).After treatment,the SSA score of the combined group was lower than that of the control group,and the scores of VFSS and Kubota drinking water test were higher than those of the control group(P<0.05);the total clinical effective rate of the combined group(95.24%)was significantly better than that of the control group(84.13%),with statistically significant difference(χ^(2)=4.201,P<0.05).Conclusion The effect of tongue muscle training combined with swallowing function training in treating patients with dysphagia after stroke has been affirmed.It can significantly reduce the degree of dysphagia,improve the swallowing function,and gradually return the patient′s daily food intake to normal.