正念放松理念在脑卒中吞咽障碍患者吞咽功能训练中的应用

史优波 何松彬 吴舟娜 戴方瑜

[摘要] 目的 研究正念放松理念在腦卒中吞咽障碍患者吞咽功能训练中的应用效果。 方法 选取2018年10月至2020年5月本科室收治的脑卒中合并吞咽障碍患者70例，分别纳入观察组和对照组，每组各35例，对照组进行吞咽训练及常规护理，观察组在此基础上实行正念放松训练;比较两组干预后吞咽障碍程度及干预前后脑卒中患者功能锻炼依从性量表、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、生活质量健康调查简表（SF-36）评估结果。 结果 观察组干预后无吞咽障碍患者比例（40.00%）显著高于对照组（17.14%），差异有统计学意义（P<0.05）。观察组干预后身体锻炼依从为（15.11±2.05）分、锻炼检测依从（7.37±1.26）分，显著高于对照组[（14.14±1.97）分、（6.71±1.34）分]，差异有统计学意义（P<0.05）。观察组干预后HAMA为（6.83±1.58）分、HAMD（5.66±0.84）分，显著低于对照组[（7.57±1.40）分、（6.14±0.85）分]，差异有统计学意义（P<0.05）。观察组干预后活力为（17.51±2.17）分、社会功能（8.23±1.03）分、精神健康（22.31±2.36）分，显著高于对照组[（16.20±2.24）分、（7.23±1.59）分、（20.14±2.58）分]，差异有统计学意义（P<0.05）。 结论 正念放松理念可有效增强脑卒中吞咽障碍患者吞咽功能训练依从性，临床价值较高。

[关键词] 正念放松理念;脑卒中;吞咽障碍;吞咽康复训练

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2021）36-0158-06

Application of mindfulness relaxation concept in swallowing function training of stroke patients with dysphagia

SHI Youbo   HE Songbin   WU Zhouna   DAI Fangyu

Department of Neurology/Rehabilitation Medicine， Zhoushan Hospital in Zhejiang Province， Zhoushan   316000， China

[Abstract] Objective To study the application effect of mindfulness relaxation concept in swallowing function training for stroke patients with dysphagia. Methods A total of 70 patients with stroke complicated with dysphagia admitted to our department from October 2018 to May 2020 were divided into the observation group and the control group， with 35 cases in each group.The control group received dysphagia training and conventional nursing， while the observation group received mindfulness relaxation training on this basis. The degree of dysphagia after intervention and the evaluation results of functional exercise compliance scale， Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale （HAMD） and 36-Item Short Form Health Survey （SF-36） of the stroke patients before and after intervention were compared between the two groups. Results After the intervention， the proportion of the patients without dysphagia was significantly higher in the observation group （40.00%） than that in the control group（17.14%），and the difference was statistically significant（P<0.05）.After intervention， the scores of compliance with physical activity and the compliance with exercise test were （15.11±2.05）points and （7.37±1.26） points，respectively in the observation group， which were significantly higher than those in the control group [（14.14±1.97） points and （6.71±1.34） points]， with statistically significant differences （P<0.05）. HAMA and HAMD scores were significantly lower in the observation group[（6.83±1.58）points， （5.66±0.84） points] than those in the control group [（7.57±1.40） points，（6.14±0.85） points] after intervention， and the differences were statistically significant（P<0.05）. After intervention， the scores of vitality， social function and mental health were significantly higher in the observation group [（17.51±2.17） points， （8.23±1.03） points and （22.31±2.36） points] than those in the control group [（16.20±2.24） points，（7.23±1.59）points， （20.14±2.58）points]， with statistically significant differences（P<0.05）. Conclusion Mindfulness relaxation concept can effectively enhance the compliance with swallowing function training for stroke patients with dysphagia， with high clinical value.

[Key words] Mindfulness relaxation concept; Stroke; Dysphagia; Swallowing rehabilitation

脑卒中作为一种急性出血性或缺血性脑疾病，能引起严重的神经损伤，进而影响患者的生活质量[1]。流行病学研究显示，卒中事件的不斷攀升不仅增加我国中老年人口死亡率，还使得75%的患者丧失劳动力，给我国社会卫生系统带来严重负担[2]。吞咽障碍作为卒中后脑损伤引起的功能障碍，可危及患者生命安全[3]。……