基于容积黏度试验测试的摄食训练对脑卒中后吞咽障碍患者的影响

Effect of Ingestion Training Guided by Volume-viscosity Swallow Test on Post-Stroke Dysphagia

目的:观察基于容积黏度试验(V-VST)测试的摄食训练对脑卒中后吞咽障碍患者吞咽功能及生活质量的影响。方法:选取2019年1月—2020年12月在上海交通大学附属上海市第六人民医院老年科进行治疗的脑卒中后吞咽障碍患者150例,采用随机数字表法分为对照组和观察组,每组75例。对照组接受常规治疗及冷刺激训练、漱口等传统康复训练,15 min/次,2次/d,6 d/周,连续治疗8周;观察组在对照组的基础上接受基于V-VST测试的摄食训练,10 min/次,3次/d,6 d/周,连续治疗8周。于治疗前后采用电视透视吞咽造影(VFSS)评估2组患者吞咽功能;采用表面肌电分析系统检测表面肌电图(sEMG)和吞咽时程;采用VFSS系统检查舌骨喉复合体动度;采用上臂围、小腿围及营养风险筛查表2002(NRS 2002)评估2组患者营养状况;采用吞咽障碍特异性生活质量量表(SWAL-QOL)评估生活质量;采用Rosenbek误吸程度分级标准评估患者误吸程度。结果:①VFSS评分:与治疗前比较,2组患者治疗后咽喉期及口腔期VFSS评分均明显升高(P<0.05)。与对照组比较,观察组治疗后咽喉期及口腔期VFSS评分均明显更高,差异均有统计学意义(P<0.05)。②喉肌sEMG吞咽时程及最大波幅值:与治疗前比较,2组治疗后喉肌sEMG吞咽时程均明显缩短,最大波幅值明显升高(P<0.05)。与对照组比较,观察组治疗后喉肌sEMG吞咽时程明显更短,最大波幅值明显更高,差异均有统计学意义(P<0.05)。③舌骨喉复合体动度:与治疗前比较,2组治疗后舌骨前移、舌骨上移距离明显增加(P<0.05)。与对照组比较,观察组治疗后舌骨前移、舌骨上移距离明显更大,差异均有统计学意义(P<0.05)。④营养状况:与治疗前比较,2组治疗后上臂围、小腿围明显增大,NRS 2002评分降低(P<0.05)。与对照组比较,观察组治疗后上臂围、小腿围明显更大,NRS2002评分明显更低,差异均有统计学意义(P<0.05)。⑤生活质量:与治疗前比较,2组治疗后SWAL-QOL评分均明显升高(P<0.05)。与对照组比较,观察组治疗后SWAL-QOL评分明显更高,差异具有统计学意义(P<0.05)。⑥误吸程度:观察组治疗后误吸程度分级情况优于对照组(P<0.05)。结论:基于V-VST测试的摄食训练能提高脑卒中后吞咽障碍患者吞咽功能,降低误吸程度,改善营养状况和生活质量。

Objective:To observe the effect of ingestion training guided by volume-viscosity swallow test(V-VST)on swallowing functions and quality of life of patients with dysphagia after stroke.Methods:A total of 150 patients with dysphagia after stroke who were treated in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 2019 to December 2020,were recruited and randomly divided into control group and observation group,with 75 cases in each group.The control group received traditional rehabilitation training,such as conventional therapy,cold stimulation training,mouthwash and so on,15 minutes a time,twice a day,six days a week,lasting for eight weeks.The observation group received ingestion training guided by the V-VST in addition to the traditional rehabilitation training methods of the control group,10 minutes a time,three times a day,six days a week,lasting for eight weeks.Before and after treatment,video fluoroscopy swallowing study(VFSS)was used to evaluate the swallowing functions;surface electromyography analysis system was used to detect surface electromyography(sEMG)and swallowing duration;upper arm and calf circumferences were measured and nutritional risk screening 2002(NRS 2002)was used to evaluate the nutritional status of patients;the swallowing-quality of life(SWAL-QOL)scale was used to evaluate the quality of life;Rosenbek aspiration classification standard was used to evaluate the degree of aspiration.Results:(1)VFSS score:compared with those before treatment,the swallowing function scores in the pharyngeal and oral stages after treatment significantly increased in both groups(P<0.05).Compared with the control group,the swallowing function scores of the observation group in the pharyngeal and oral stages were significantly higher after treatment(P<0.05).(2)Swallowing duration and maximum amplitude of laryngeal muscle by sEMG:compared with those before treatment,the swallowing duration of laryngeal muscle measured by sEMG was significantly shortened and the maximum amplitude significantly increased in both groups(P<0.05).Compared with the control group,swallowing duration of laryngeal muscle by sEMG of the observation group was significantly shorter and the maximum amplitude was significantly higher after treatment(P<0.05).(3)Hyoid laryngeal complex mobility:compared with those before treatment,the distances of hyoid bone forward displacement and upward displacement of both groups significantly increased after treatment(P<0.05).Compared with the control group,the distances of the hyoid bone forward displacement and upward displacement of the observation group was significantly higher after treatment(P<0.05).(4)Nutritional status:compared with those before treatment,the upper arm and calf circumferences of both groups increased significantly after treatment,and the NRS 2002 score decreased significantly(P<0.05).Compared with the control group,the upper arm and calf circumferences of the observation group were significantly greater after treatment,and the NRS 2002 score was significantly lower(P<0.05).(5)Quality of life:compared with those before treatment,the SWAL-QOL scores of both groups increased significantly after treatment(P<0.05).Compared with the control group,the SWAL QOL score of the observation group was significantly higher after treatment(P<0.05).(6)Degree of aspiration:compared with the control group,the degree of aspiration of the observation group was lower after treatment(P<0.05).Conclusion:Ingestion training guided by V-VST can improve the swallowing function of patients with dysphagia after stroke,reduce the degree of aspiration,and improve the nutritional status and quality of life.