中西医结合治疗脑卒中后环咽肌失迟缓型吞咽障碍40例临床观察

Clinical Observation on the Treatment of 40 Cases of Dysphagia of Cricopharyngeal Muscle After Stroke with Integrated Traditional Chinese and Western Medicine

目的:观察、探讨中西医结合治疗脑卒中后环咽肌失迟缓型吞咽障碍的可行性及临床康复疗效。方法:将诊断为脑卒中后环咽肌失迟缓型吞咽障碍的80例患者,使用随机数字表法分为对照组和观察组,每组各40例。对照组采用球囊扩张术治疗,观察组采用“醒脑开窍”针刺法联合球囊扩张术治疗。每日1次,6次/周,星期日不治疗,共治疗4周。观察比较治疗后两组的临床疗效,记录治疗前后洼田饮水试验(WST)评分、标准吞咽功能评估量表(SSA)评分、视频吞咽造影检查(VFSS)评分的变化,以及治疗前后进食食物性状的变化。结果:与同组治疗前相比,对照组和观察组WST、SSA评分均下降,VFSS评分均升高,差异有统计学意义(P<0.05);但观察组在提高患者吞咽功能方面明显优于对照组(P<0.05);治疗4周后,对照组总有效率为85.0%,观察组总有效率为95.0%,观察组临床疗效明显高于对照组(P<0.05)。结论:中西医结合治疗脑卒中后环咽肌失迟缓型吞咽障碍的方案安全可行,效果显著,能有效促进患者吞咽功能的康复,改善患者生存质量,增强患者自信心,提升患者生活水平,可在临床中大力推广应用。

Objective To observe and discuss the feasibility and clinical rehabilitation effect of integrated traditional Chinese and western medicine in treating dysphagia of cricopharyngeal muscle after stroke.Methods A total of 80 patients with poststroke cyclopharyngeal dysphagia were divided into control group and observation group by random number table method,with 40 cases in control group and observation group respectively.the control group was treated with balloon dilation and the observation group with“Xingnao Kaiqiao”acupuncture combined with balloon dilation.Patients were treated once a day,six times a week,Sunday rest day,f a total of 4 weeks.Monitor and compare the clinical efficacy of the two patient groups after treatment,the changes in Watian Drinking Water Test(WST),the Standard Swallowing Function Assessment Scale(SSA),the VFSS score before and after treatment,as well as the changes in dietary characteristics before and after treatment.Results Compared to the same group prior to treatment,patients WST and SSA levels decreased in both groups and VFSS levels increased,with a statistically significant difference(P<0.05);However,the observation group was significantly better at improving swallowing function than the control group(P<0.05).After 4 weeks of treatment,the total effective rates of the control group and the observation group were 85.0%and 95.0%,respectively.The clinical efficacy of the observation group was significantly higher than that of the control group(P<0.05);Conclusion The treatment of cricopharyngeal achalasia dysphagia after stroke with integrated traditional Chinese and western medicine is safe and feasible,and has significant effect.It can effectively promote the rehabilitation of patients swallowing function,improve the quality of life of patients,enhance patients self-confidence,and improve patients living standards,which can be widely applied in clinical practice.