想象训练对脑卒中神经性吞咽障碍患者近期生活质量及吞咽功能的影响
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摘要
目的探讨想象训练对脑卒中神经性吞咽障碍患者近期生活质量及吞咽功能的影响。方法选取2016年8月—2018年2月衢州市人民医院收治的脑卒中神经性吞咽障碍患者60例,按照随机数字表法分为试验组与对照组,每组各30例。对照组在常规康复训练基础上使用吞咽障碍治疗仪治疗,试验组在对照组基础上给予运动想象疗法干预。干预6周后比较2组患者的生活质量、吞咽功能及并发症。结果干预6周后,2组患者标准吞咽功能评定量表(standardized swallowing assessment,SSA)评分均显著低于干预前(均P<0.05),且试验组SSA评分显著低于常规组,组间比较差异有统计学意义(P<0.05);2组患者吞咽障碍特异性生活质量量表(swallowing-related quality of life,SWAL-QOL)总分以及各维度评分均显著高于干预前(均P<0.05),且试验组SWAL-QOL总分以及各维度评分均显著高于对照组,组间比较差异有统计学意义(均P<0.05);干预期间,2组患者并发症发生率比较差异无统计学意义(P>0.05)。结论吞咽治疗仪结合运动想象训练可有效改善卒中神经性吞咽障碍患者的吞咽功能,提高生活质量,且未增加并发症的发生,值得临床重视。
Objective To investigate the influence of pharyngeal treatment machine supplemented with motor imaging training on quality of life and swallowing function of stroke patients with deglutition disorder.Methods Sixty cases of stroke patients with deglutition disorder from August 2016 to February 2018 in our hospital were selected. According to the random number table method, all the patients were divided into the experiment group and the control group, 30 cases in each group. The control group was treated with dysphagia therapy on the basis of routine rehabilitation training; the experiment group was given motor imagery therapy on the basis of the control group. After 6 weeks of intervention, the quality of life, swallowing function and complications were compared between the two groups. Results After 6 weeks of intervention, the SSA scores of the two groups were significantly lower than those before intervention(P<0.05), the SSA score of the experiment group was significantly lower than that of the conventional group, the difference were statistically significant(all P<0.05). The SWAL-QOL scores of the two groups were significantly higher than those before intervention(P<0.05), the total score of SWAL-QOL and the scores of all dimensions in the experimental group were significantly higher than those in the control group, the difference were statistically significant(all P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Pharyngeal treatment machine supplemented with motor imaging training can effectively improve the swallowing function of patients with dysphagia neurogenic dysphagia, improve the quality of life, and do not increase the incidence of complications, it is worthy of clinical attention.
Objective To investigate the influence of pharyngeal treatment machine supplemented with motor imaging training on quality of life and swallowing function of stroke patients with deglutition disorder.Methods Sixty cases of stroke patients with deglutition disorder from August 2016 to February 2018 in our hospital were selected. According to the random number table method, all the patients were divided into the experiment group and the control group, 30 cases in each group. The control group was treated with dysphagia therapy on the basis of routine rehabilitation training; the experiment group was given motor imagery therapy on the basis of the control group. After 6 weeks of intervention, the quality of life, swallowing function and complications were compared between the two groups. Results After 6 weeks of intervention, the SSA scores of the two groups were significantly lower than those before intervention(P<0.05), the SSA score of the experiment group was significantly lower than that of the conventional group, the difference were statistically significant(all P<0.05). The SWAL-QOL scores of the two groups were significantly higher than those before intervention(P<0.05), the total score of SWAL-QOL and the scores of all dimensions in the experimental group were significantly higher than those in the control group, the difference were statistically significant(all P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Pharyngeal treatment machine supplemented with motor imaging training can effectively improve the swallowing function of patients with dysphagia neurogenic dysphagia, improve the quality of life, and do not increase the incidence of complications, it is worthy of clinical attention.
引文
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[13] 刘颖,李翔宇,汤宇,等.中医康复护理对脑卒中患者65例吞咽障碍的影响[J].山西医药杂志,2016,45(11):1351-1353.
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[16] 曹湾,陈启波,李荣祝,等.病房-家庭式运动想象康复训练技术对脑卒中大脑可塑性影响[J].中国康复医学杂志,2016,31(4):471-474.
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[18] 章惠英,陈蓄,章雅青,等.运动想象指导语的制订及用于脑卒中偏瘫患者上肢运动功能康复研究[J].护理学杂志,2016,31(19):80-83.
[19] MARY K D,LITA I E.Effects on facial dysfunction and Swallowing Capacity of intraoral stimulation early and late after stroke[J].Neuro Rehabilitation,2015,36(1):101-106.
[20] YEH T T,CHANG K C,WU C,et al.Effects and mechanism of the HECT study (hybrid exercise-cognitive trainings) in mild ischemic stroke with cognitive decline:fMRI for brain plasticity,biomarker and behavioral analysis[J].Contemp Clin Trials Commun,2018,9:164-171.
[2] 吴亚哲,陈伟伟.中国脑卒中流行概况[J].心脑血管病防治,2016,16(6):410-414.
[3] 刘有山.神经肌肉电刺激联合吞咽康复训练治疗脑卒中后吞咽障碍的疗效及其对舌骨喉复合体动度的影响[J].中华全科医学,2017,15(10):1782-1785.
[4] 张艳明.高压氧联合针灸治疗急性脑卒中后吞咽障碍效果观察[J].现代中西医结合杂志,2017,26(2):167-169.
[5] KERTSCHER B,SPEYER R,PALMIERI M,et al.Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders:an updated systematic review[J].Dysphagia,2014,29(2):204-212.
[6] 赵琳,郭兵妹,高元鹏,等.运动想象疗法在脑卒中偏瘫患者下肢运动功能障碍远程康复护理中应用的研究进展[J].护士进修杂志,2017,32(17):1565-1568.
[7] 刘鸣,刘峻峰,吴波.脑血管病分类分型进展与解读[J].中华神经科杂志,2017,50(3):163-167.
[8] 刘晓娟,修晓青,庞恒元,等.心理干预对脑卒中后吞咽障碍患者功能恢复和生活质量的效果[J].蚌埠医学院学报,2016,41(7):979-980.
[9] 胡晓梅,董梅花,翟剑霜,等.标准吞咽功能评估量表在脑卒中误吸风险评估中的应用研究[J].护士进修杂志,2016,31(16):1447-1449.
[10] 李洪丽,苗善智,杨坚,等.脑卒中伴吞咽障碍患者不同训练方法的疗效观察[J].中国医药导报,2016,13(28):44-47.
[11] 陆东英.康复治疗在脑卒中患者康复中的临床应用效果[J].实用临床医药杂志,2017,21(4):175-177.
[12] 王志勇,宋书昌,王利春,等.针刺联合仿生物电刺激治疗脑卒中后吞咽困难的临床研究[J].中西医结合心脑血管病杂志,2014,8(8):923-924.
[13] 刘颖,李翔宇,汤宇,等.中医康复护理对脑卒中患者65例吞咽障碍的影响[J].山西医药杂志,2016,45(11):1351-1353.
[14] 张琪涵.运动执行与运动想象大脑激活模式的比较[D].天津:天津师范大学,2016.
[15] 朱峰.电针结合具身运动想象疗法对脑梗死后偏瘫的临床研究[D].南京:南京中医药大学,2017.
[16] 曹湾,陈启波,李荣祝,等.病房-家庭式运动想象康复训练技术对脑卒中大脑可塑性影响[J].中国康复医学杂志,2016,31(4):471-474.
[17] SUBRAMANIAN L,MORRIS M B,BROSNAN M,et al.Functional magnetic resonance imaging neurofeedback-guided motor imagery training and motor training for parkinson’s disease:randomized trial[J].Front Behav Neurosci,2016,10:111.
[18] 章惠英,陈蓄,章雅青,等.运动想象指导语的制订及用于脑卒中偏瘫患者上肢运动功能康复研究[J].护理学杂志,2016,31(19):80-83.
[19] MARY K D,LITA I E.Effects on facial dysfunction and Swallowing Capacity of intraoral stimulation early and late after stroke[J].Neuro Rehabilitation,2015,36(1):101-106.
[20] YEH T T,CHANG K C,WU C,et al.Effects and mechanism of the HECT study (hybrid exercise-cognitive trainings) in mild ischemic stroke with cognitive decline:fMRI for brain plasticity,biomarker and behavioral analysis[J].Contemp Clin Trials Commun,2018,9:164-171.