标准吞咽功能评估下吞咽康复训练对脑卒中吞咽功能障碍患者康复效果的影响

马军廷 袁燕

[摘要] 目的 探討标准吞咽功能评估下吞咽康复训练对脑卒中吞咽功能障碍患者康复效果的影响。 方法 选取2011年1月～2016年12月在聊城市人民医院就诊的脑卒中后吞咽功能障碍患者104例，按随机数字表法分为对照组和观察组，每组各25例。对照组患者实施常规康复训练，观察组患者实施标准吞咽功能评估下吞咽康复训练，于康复训练前后行吞咽功能、言语功能评定，并行营养指标检测，比较两组患者的临床疗效及不良事件情况。 结果 康复训练后，两组患者两组患者血清白蛋白、血红蛋白、转铁蛋白、前白蛋白、总胆固醇、三酰甘油较康复训练前均增加，且观察组水平高于对照组，差异有高度统计学意义（P < 0.01）。康复训练后，两组患者的Burke吞咽障碍筛查量表评分（Burke评分）、美国国立卫生研究院卒中量表（NHISS评分）、标准吞咽功能评估（SSA）评分均较康复训练前降低，吞咽视频内镜检查（VESS）评分增加，且观察组优于对照组，差异有统计学意义（P < 0.05）。洼田氏饮水试验，经过康复训练后，两组患者喝温开水所需时间、所需次数及呛咳次数均减少，且观察组优于对照组，差异有统计学意义（P < 0.05）。观察组患者的治疗有效率高于对照组，差异有统计学意义（P < 0.05）。观察组患者不良反应率低于对照组，差异有统计学意义（P < 0.05）。 结论 标准吞咽功能评估下吞咽康复训练可提高脑卒中吞咽功能障碍患者的康复效果，值得临床推广使用。

[关键词] 标准吞咽功能评估；吞咽康复训练；脑卒中；吞咽功能障碍；康复效果

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210（2018）06（b）-0056-06

[Abstract] Objective To investigate influence of swallowing rehabilitation training under standard swallowing function evaluation on rehabilitation effect in stroke patients with swallowing dysfunction. Methods From January 2011 to December 2016， in Liaocheng People′s Hospital， 104 patients with dysphagia after stroke were selected， according to the random digital table method， they were divided into the control group and observation group， with 52 cases in each group. The control group received routine rehabilitation training， observation group received swallowing rehabilitation training under standard swallowing function evaluation. Swallowing function and speech function were evaluated before and after rehabilitation training， and the nutrition indexes were detected， the clinical efficacy and adverse events in two groups were compared. Results After the rehabilitation training， the levels of albumin， hemoglobin， transferrin， prealbumin， total cholesterol， triglyceride in two groups increased compared with before rehabi litation， and those in the study group were better than those in the control group， the differences were statistically significant （P < 0.01）. After rehabilitation training， the scores of Burke， NHISS and SSA in both groups decreased compared with before rehabi litation， VESS increased， and these in the study group were better than those in the control group， the differences were statistically significant （P < 0.01）. After rehabilitation training， in the Watian drinking water test， the drinking time and choking phlegm times in two groups significantly decreased， and these in the study group were better than those in the control group， the differences were statistically significant （P < 0.05）. The treatment efficiency in the study group was higher than that in the control group， the difference was statistically significant （P < 0.05）. The rate of adverse events in the study group was lower than that in the control group， the difference was statistically significant （P < 0.05）. Conclusion Swallowing rehabilitation training under standard swallowing function evaluation can improve rehabilitation effect in stroke patients with swallowing dysfunction， which is worthy of clinical use.

[Key words] Standard swallowing function evaluation； Swallowing rehabilitation training； Stroke； Swallowing dysfunction； Rehabilitation effect

相关文献统计，我国每年约有200万人发生脑卒中，存活人数约有50万人，而存活的患者中大部分留有吞咽、言语及肢体功能障碍等后遗症[1-2]。吞咽功能障碍主要原因是脑神经反射性活动退化及吞咽肌群不协调，而导致患者出现呛咳或误吸等吞咽障碍，从而引起患者可能出现窒息、吸入性肺炎、脱水及营养不良等，而严重影响患者生活质量[3-4]。因此，对脑卒中患者进行吞咽功能的早期评估和早期诊断，同时给予康复训练，重建吞咽功能是临床中的工作重点。对脑卒中患者实施有效的干预措施，重建吞咽功能是医护人员主要工作之一。……