吞咽障碍训练仪配合基于咳嗽反射的肺康复对吸入性肺炎的疗效

Dysphagia Training Device and Pulmonary Rehabilitation Based on Cough Reflex in the Treatment of Older Patients with Aspiration Pneumonia

目的探讨吞咽障碍训练仪配合基于咳嗽反射的肺康复在老年吞咽障碍致吸入性肺炎患者中的应用效果。方法选取2020年1月~2021年8月华北理工大学附属医院收治的98例老年吞咽障碍致吸入性肺炎患者作为研究对象。按照随机数字表法将患者分为对照组和联合组,各49例。两组在常规治疗基础上分别采用基于咳嗽反射的肺康复和吞咽障碍训练仪配合基于咳嗽反射的肺康复,干预2周。比较临床疗效,干预前后采用吞咽困难亚量表评估吞咽障碍程度,电视透视检查吞咽功能,DANTEC高速肌电和诱发电位系统测定相关肌肉的时限、肌电图振幅及多相位电,肺功能检测仪检测肺功能[呼气峰值流速占预测值百分比(PEF%pred)、第1秒用力呼气容积占预测值百分比(FEV1%pred)、呼出气一氧化氮(FeNO)],记录两组住院时间和病死率。结果联合组总有效率高于对照组(P<0.05);干预1周、2周后两组吞咽障碍程度均较干预前降低,且联合组低于对照组(P<0.05);干预后相比对照组,联合组咽喉期、口腔期液体状、稀稠状、糊状评分均升高(P<0.05);干预后联合组肌电图振幅、时限、多相位电均低于对照组(P<0.05);干预后联合组PEF%pred、FEV1%pred高于对照组,FeNO低于对照组(P<0.05);联合组住院时间短于对照组(P<0.05);两组病死情况比较,差异无统计学意义(P>0.05)。结论吞咽障碍训练仪联合基于咳嗽反射的肺康复可恢复老年吞咽障碍致吸入性肺炎患者的吞咽功能,降低吞咽障碍程度,改善肺功能,促进疾病康复,缩短住院时间。

Objective To explore the application effect of dysphagia training device combined with pulmonary rehabilitation based on cough reflex in older patients with aspiration pneumonia caused by dysphagia.Methods Ninety-eight patients with aspiration pneumonia due to swallowing disorder admitted to the Affiliated Hospital of North China University of Science and Technology from January 2020 to August 2021 were selected in this study.The patients were divided into a control group(49 cases)and a combination group(49 cases)according to the random number table.All patients were treated with conventional treatment.The patients in the control group were additionally treated with cough reflex-based pulmonary rehabilitation for two weeks,and those in the combination group were additionally treated with dysphagia training device and cough reflex-based pulmonary rehabilitation.The clinical outcomes were compared.The level of dysphagia was assessed using dysphagia subscale before and after intervention.The swallow function was examined by TV fluoroscopy.The time frames,EMG amplitude and multiphase potential of the relevant muscles were measured by DANTEC high-speed EMG and evoked potential system.Lung function was measured by a pulmonary function test including PEF%pred,FEV1%pred and fractional exhaled nitric oxide(FeNO).Length of stay and mortality were recorded.Results The overall response rate in the combination group was higher than that in the control group(P<0.05).After 1 week and 2 weeks of intervention,the level of dysphagia was lower in both groups than that before intervention,and was lower in the combination group than in the control group(P<0.05).Compared with the control group,the liquid,mushy and pasty barium scores in the pharyngeal and oral phases were increased in the combination group after intervention(P<0.05).EMG amplitude,time frame and multiphase potential were lower in the combination group than in the control group(P<0.05).PEF%pred and FEV1%pred were higher in the combination group than in the control group,while FeNO was lower than in the control group(P<0.05).The length of hospital stay was shorter in the combination group than in the control group(P<0.05).There was no significant difference in mortality rate between the two groups(P>0.05).Conclusion Dysphagia training device combined with pulmonary rehabilitation based on cough reflex may improve the swallow function and lung function of older patients with aspiration pneumonia caused by dysphagia,promote recovery from disease and shorten hospital stay.