放散式体外冲击波疗法用于缺血性脑卒中合并吞咽障碍患者的价值

Dispersive extracorporeal shock wave therapy the value of it in ischemic stroke patients with dysphagia

目的探讨放散式体外冲击波疗法(rESWT)用于缺血性脑卒中合并吞咽障碍患者的价值。方法选取上海中医药大学附属曙光医院康复医学科2022年1月~2023年1月收治的缺血性脑卒中合并吞咽障碍患者108例,抽签随机分为观察组和对照组,各54例。对照组进行吞咽康复训练,观察组在对照组基础上结合rESWT干预治疗。采用洼田饮水试验(WST)评估两组患者干预效果;采用标准吞咽功能评估量表(SSA)、功能性经口摄食量表(FOIS)和渗漏-误吸评分(PAS)评估吞咽功能;采用吞咽障碍特异性生活质量量表(SWAL-QOL)和生活质量综合评定问卷(CQOL-74)评估生活质量;记录两组患者不良反应及并发症。结果干预后,两组患者WST分级变化总体水平优于同组干预前,且观察组优于对照组,差异有统计学意义(Z=9.480,P<0.05)。干预后,两组患者SSA、PAS评分低于同组干预前,且观察组低于对照组[(20.58±2.25)分vs.(24.45±3.02)分、(1.85±0.42)分vs.(2.91±0.76)分],差异有统计学意义(t=7.551、8.971,P<0.05);FOIS评分高于同组干预前,且观察组高于对照组[(5.88±1.12)分vs.(5.04±1.16)分],差异有统计学意义(t=3.828,P<0.05)。干预后,两组患者CQOL-74各项评分和SWAL-QOL评分均高于同组干预前,且观察组高于对照组[(76.13±4.76)分vs.(66.48±4.55)分、(77.43±3.46)分vs.(63.15±3.51)分、(81.52±4.68)分vs.(71.05±4.75)分、(157.24±14.54)分vs.(132.14±13.75)分],差异有统计学意义(t=10.769、21.291、11.538、9.217,P<0.05)。观察组并发症发生率显著低于对照组(1.85%vs.12.96%),差异有统计学意义(χ^(2)=4.860,P=0.027)。结论rESWT可有效促进缺血性脑卒中合并吞咽障碍患者早期吞咽功能恢复,提高其生活质量,且安全性良好,具有一定临床应用价值。

Objective To explore the value of rESWT in ischemic stroke patients with Dysphagia.Methods A total of 108 patients with ischemic stroke complicated with dysphagia who were admitted to the Department of Rehabilitation Medicine,Shuguang Hospital Affiliated to the University of Traditional Chinese Medicine from January 2022 to January 2023 were selected and randomly divided into an observation group and a control group,with 54 cases in each group.The control group received swallowing rehabilitation training,while the observation group received rESWT intervention treatment on the basis of the control group.The Watian Swallowing Test(WST)was used to evaluate the intervention effect.The Swallowing Severity Scale(SSA),Functional Oral Intake Scale(FOIS),and Penetration-Aspiration Scale(PAS)were used to evaluate the swallowing function.The quality of life was assessed with the dysphagia-specific quality of life inventory(SWAL-QOL)and the general quality of life inventory(CQOL-74),and the adverse reactions and complications were recorded.Results After intervention,the overall level of WST grading changes in both groups of patients was better than before intervention in the same group,and the observation group was better than the control group(Z=9.480,P<0.05).After intervention,the SSA and PAS scores of the two groups of patients were lower than those of the same group before intervention,and the observation group was lower than the control group(t=7.551,8.971,P<0.05).The FOIS score was higher than before intervention in the same group,and the observation group was higher than the control group(t=3.828,P<0.05).After intervention,the CQOL-74 scores and SWAL-QOL scores of both groups of patients were higher than those of the same group before intervention,and the observation group was higher than the control group(t=10.769,21.291,11.538,9.217,P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=4.860,P=0.027).Conclusion rESWT can effectively promote the early recovery of swallowing function in ischemic stroke patients with dysphagia,improve their quality of life,and has good safety,which has certain clinical application value.