神经肌肉电刺激结合饮食指导对卒中后吞咽障碍患者的疗效

摘要

目的 探究神经肌肉电刺激结合饮食指导对脑卒中后吞咽障碍的治疗,并分析其治疗效果.方法 选择2014年6月—2016年10月因脑卒中后首次出现吞咽障碍患者95例纳入本次研究,并随机分为研究组(47例)和对照组(48例);后因肺部感染等病因出现脱落,研究组脱落2例,对照组脱落3例.对照组采用传统吞咽康复训练,研究组患者则在进行传统吞咽康复训练基础上,根据吞咽障碍发生原因,进行神经肌肉电刺激治疗,并结合相应的饮食指导,包括改进食物性状、调整患者进食体位、针对性改进喂养方法、选择进食器具、训练吞咽技巧等方面进行全面指导.为评估治疗效果,对脑卒中吞咽障碍患者于治疗前后分别采用电视荧光放射吞咽功能检查(VFSS)评分法、功能性经口摄食量表(FOIS)、视频吞咽造影功能障碍量表(VDS)评价患者吞咽功能.结果 训练后两组的吞咽功能评分较训练前均有显著提高(P＜0.05),但训练后研究组功能评分明显高于对照组(P＜0.05),研究组的好转情况要显著优于对照组.两组患者干预前,摄食情况、VDS评分比较,差异无统计学意义(P＞0.05);干预后,两组患者摄食情况、VDS评分均存在一定程度改善,且研究组优于对照组(P＜0.05).研究组治疗总有效率为86.67%,对照组为68.90%,研究组高于对照组(χ2=3.38,P=0.026).结论 神经肌肉电刺激结合饮食指导训练对改善脑卒中患者吞咽功能障碍的疗效优于单纯吞咽训练.%Objective To explore the therapeutic effect of neuromuscular electrical stimulation combined with dietary guidance on dysphagia after stroke. Methods A total of 95 patients with dysphagia after cerebral apoplexy were enrolled in this study from June 2014 to October 2016, and were randomly divided into the study group and the control group. There were 47 cases in the case group and 48 cases in the control group. There were 2 cases of shedding in the case group and 3 cases in the control group due to pulmonary infection. The control group received traditional swallowing rehabilitation training. On the basis of traditional swallowing rehabilitation training, the patients in the case group received neuromuscular electrical stimulation therapy according to the causes of swallowing disorders, combined with corresponding dietary guidance, including improving food characteristics, adjusting patients' eating position, improving feeding methods, choosing eating apparatus, training swallowing skills and so on. To evaluate the efficacy of the treatment, vidio fluoroscopic swallowing study (VFSS), Functional Oral Intake Scale (FOIS) and Videofluoroscopic Dysphagia Scale (VDS) were applied to evaluate patients with dysphagia after stroke. Results The functional scores of the two groups were significantly improved after the training (P＜ 0.05). The functional score of the case group after training was significantly higher than that of the control group (P＜ 0.05). The improvement of the case group was significantly better than that of the control group. Before the intervention of the two groups, the feeding condition and VDS score were not statistically significant (P＞ 0.05). After the intervention, the feeding situation and VDS score of both groups were improved to a certain extent, and the case group was superior to the control group (P＜0.05). The total effective rate of the case group was 86.67%, the control group was 68.90%, and the case group was higher than the control group (χ2=3.38, P=0.026). Conclusions Neuromuscular electrical stimulation combined with dietary guidance and swallowing training has a better improvement of swallowing dysfunction in patients after stroke than using swallowing training alone.