功能训练辅以营养干预治疗脑卒中后吞咽功能障碍的临床观察

摘要

Objective:To observe the effect of functional training with nutritional intervention on swallowing dysfunction aftcr stroke.Methods:Eighteen stroke patients with swallowing dysfunction in our hospital were randomly divided into two groups.Forty cases in the control group were treated with swallowing function training and 40 patients in the observation group were given functional training with nutrition intervention treatment.Kubota drinking water tests were performed to evaluate swallowing function,and the total protein (TP),albumin (propagated) and prealbumin (Hb),body weight,triceps skinfold,upper arm circumference,upper arm muscle circumference changes were checked before and after treatment.The complications were recorded.Results:After 4 weeks of treatment,the VFSS scores of the patients in two groups were significantly higher than those before treatment (P＜ 0.05),and the VFSS score in the observation group was higher than that in the control group (P＜0.05).The incidence of complications in the observation group was significantly lower than that in the control group (P＜0.05).After treatment,TP,ALB and Hb in the control group were significantly lower than those before treatment and the observation group (all P＜0.05).The above indexes had no significant difference in the observation group before and after treatment.After treatment,body mass index,triceps skinfold thickness and arm muscle circumference were significantly reduced in the control group as compared with those before treatment and observation group after treatment (P＜0.05).The above indexes had no significant difference in the observation group before and after treatment.Conclusion:The functional training with nutritional intervention is more systematic and scientific to treat swallowing dysfunction after stroke,and is an effective strategy to improve the rehabilitation effect and the nutritional status,and reduce the incidence of complications in patients with swallowing dysfunction.%目的:观察功能训练辅以营养干预治疗脑卒中后吞咽功能障碍的效果.方法:将脑卒中后吞咽功能障碍患者80例随机分为2组各40例,2组均进行吞咽功能训练,对照组给予常规肠内营养支持,观察组辅以全营养型个体化营养干预治疗,治疗前、后均行洼田饮水试验评价吞咽功能改善情况,并检查总蛋白(TP)、白蛋白(ALB)、前白蛋白(Hb)、体重、三头肌皮褶厚度、上臂围、上臂肌围变化,记录并发症发生情况.结果:治疗4周后,2组患者VFSS评分均较治疗前明显提高(P＜0.05),且观察组VFSS评分高于对照组(P＜0.05).观察组并发症发生率明显低于对照组(P＜0.05).治疗后,对照组患者TP、ALB、Hb较治疗前及观察组治疗后明显降低(P＜0.05),观察组上述指标治疗前后差异无统计学意义.治疗后,对照组体重指数、肱三头肌皮褶厚度、上臂肌围较治疗前及观察组治疗后明显降低(P＜0.05),观察组上述指标治疗前后比较差异无统计学意义.结论:功能训练辅以营养干预治疗脑卒中后吞咽功能障碍更系统化、科学化,是提高康复效果,改善患者营养状况,降低并发症发生率的有效方法.