穴位贴敷联合吞咽训练在脑卒中后吞咽障碍患者中的应用效果研究
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摘要
目的探讨穴位贴敷联合吞咽训练在脑卒中后吞咽障碍患者中的应用效果。方法选取122例脑卒中后吞咽障碍患者随机分为对照组和观察组,每组61例,均给予常规对症护理。同时,对照组给予吞咽训练干预,观察组在对照组基础上给予穴位贴敷干预。观察两组干预后吞咽障碍疗效,并对比两组干预前及干预1个月后的吞咽功能障碍改善情况、营养状况、日常生活能力和生活质量。结果干预后,观察组吞咽功能优于对照组,差异具有统计学意义。干预后,两组洼田饮水试验评分、吞咽X线电视透视检查(VFSS)评分、改良Barthel指数(MBI)评分、吞咽障碍特异性生活质量量表(SWAL-QOL)评分、血清白蛋白(ALB)含量、前白蛋白(PA)含量显著升高(P<0.05),营养风险筛查2002(NRS2O02)评分显著降低(P<0.05),且以上指标观察组的变化幅度显著大于对照组(P<0.05)。结论穴位贴敷联合吞咽训练应用于脑卒中后吞咽障碍患者疗效满意,可有效改善患者吞咽功能障碍和营养状况,提高其日常生活能力和生活质量。
Objective To explore the effect of acupoint application combined with swallowing training in patients with dysphagia after stroke. Methods A total of 122 patients with dysphagia after stroke were selected and randomly divided into control group and observation group, with 61 cases in each group. All patients were given routine symptomatic nursing. At the same time,the control group was given swallowing training intervention, while the observation group was given acupoint application intervention on the basis of the control group. The intervention efficacy of dysphagia was observed in the two groups, and the improvement of swallowing dysfunction, nutritional status, daily living ability and quality of life were compared between the two groups before intervention and after 1 month of intervention. Results After intervention, the swallowing function of the observation group was better than that of the control group, and the difference was statistically significant. After intervention, the water swallow test score,swallowing X-ray fluoroscopy(VFSS)score, modified Barthel index(MBI)score, swallowing disorder specific quality of life scale(SWAL-QOL)score, serum albumin(ALB)content, prealbumin(PA)content increased significantly in the two groups(P<0.05), and nutritional risk screening 2002(NRS2 O02)score decreased significantly(P<0.05). The change range of the above indexes in the observation group was significantly larger than that in the control group(P<0.05). Conclusion Acupoint application combined with swallowing training has satisfactory efficacy in the treatment of patients with dysphagia after stroke, and it can effectively improve the swallowing dysfunction and nutritional status, and promote the daily living ability and quality of life.
Objective To explore the effect of acupoint application combined with swallowing training in patients with dysphagia after stroke. Methods A total of 122 patients with dysphagia after stroke were selected and randomly divided into control group and observation group, with 61 cases in each group. All patients were given routine symptomatic nursing. At the same time,the control group was given swallowing training intervention, while the observation group was given acupoint application intervention on the basis of the control group. The intervention efficacy of dysphagia was observed in the two groups, and the improvement of swallowing dysfunction, nutritional status, daily living ability and quality of life were compared between the two groups before intervention and after 1 month of intervention. Results After intervention, the swallowing function of the observation group was better than that of the control group, and the difference was statistically significant. After intervention, the water swallow test score,swallowing X-ray fluoroscopy(VFSS)score, modified Barthel index(MBI)score, swallowing disorder specific quality of life scale(SWAL-QOL)score, serum albumin(ALB)content, prealbumin(PA)content increased significantly in the two groups(P<0.05), and nutritional risk screening 2002(NRS2 O02)score decreased significantly(P<0.05). The change range of the above indexes in the observation group was significantly larger than that in the control group(P<0.05). Conclusion Acupoint application combined with swallowing training has satisfactory efficacy in the treatment of patients with dysphagia after stroke, and it can effectively improve the swallowing dysfunction and nutritional status, and promote the daily living ability and quality of life.
引文
[1]吕洪艳,韩淑艳,康晋.脑卒中合并吞咽障碍的管理策略[J].中国地方病防治杂志,2017,32(11):I0003.
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[3]王舒环,张浩洋,刘海涛,等.针刺治疗脑卒中后吞咽障碍取穴规律文献研究[J].中医杂志,2017,58(16):1412-1415.
[4]高丽君,王海涛,刘木朋,等.中医针灸结合穴位敷贴治疗急性缺血性脑中风的随机、对照研究[J].辽宁中医杂志,2018,45(3):614-617.
[5]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点(1995)[J].临床和实验医学杂志,2013,12(7):559.
[6]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生版社,2009:87-88.
[7]大西幸子,孙启良.摄食、吞咽障碍康复实用技术[M].北京:中国医药科学技术出版社,2000:43.
[8]恽晓平.康复治疗评定学[M].北京:华夏出版社,2005:530.
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[10]Mchorney C A,Bricker D E,Kramer A E,et al.The SWAL-QOLoutcomes tool for oropharyngeal dysphagia in adults:I.Conceptual foundation and item development[J].Dysphagia,2000,15(3):115-121.
[11]王珊珊,顾莹,刘敏,等.口肌生物反馈训练结合常规吞咽康复训练治疗脑卒中后吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2017,39(1):27-29.
[12]张莉,刘畅,李慧敏,等.低频电刺激治疗脑卒中后吞咽障碍的疗效观察[J].实用老年医学,2018,32(5):84-86.
[13]李晓军,张玉梅,郑永强,等.六泉穴解惑刺法对缺血性脑卒中后吞咽障碍患者Hcy及生活质量的影响[J].针灸临床杂志,2016,32(2):48-50.
[14]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍随机对照研究[J].中国针灸,2016,36(4):347-350.
[15]赵妍妍,寇娟,黄娣,等.穴位贴敷配合康复训练对脑卒中后吞咽障碍的效果观察[J].中国康复医学杂志,2012,27(8):771-772.
[16]李同军,于志国,刘旭东,等.推拿结合针刺治疗痉挛性构音障碍的临床疗效观察[J].针灸临床杂志,2017,33(9):27-30.
[17]夏泳,姜敏.穴位贴敷联合中医按摩法对脑梗死恢复期患儿肢体功能障碍的影响[J].中医药导报,2017,23(6):65-68.
[2]肖卫红,吴碧玉.脑卒中后吞咽障碍的康复研究进展[J].中国康复理论与实践,2017,23(7):783-787.
[3]王舒环,张浩洋,刘海涛,等.针刺治疗脑卒中后吞咽障碍取穴规律文献研究[J].中医杂志,2017,58(16):1412-1415.
[4]高丽君,王海涛,刘木朋,等.中医针灸结合穴位敷贴治疗急性缺血性脑中风的随机、对照研究[J].辽宁中医杂志,2018,45(3):614-617.
[5]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点(1995)[J].临床和实验医学杂志,2013,12(7):559.
[6]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生版社,2009:87-88.
[7]大西幸子,孙启良.摄食、吞咽障碍康复实用技术[M].北京:中国医药科学技术出版社,2000:43.
[8]恽晓平.康复治疗评定学[M].北京:华夏出版社,2005:530.
[9]缪鸿石,朱镛连.脑卒中康复评定和治疗[M].北京:华夏出版社,1996:22.
[10]Mchorney C A,Bricker D E,Kramer A E,et al.The SWAL-QOLoutcomes tool for oropharyngeal dysphagia in adults:I.Conceptual foundation and item development[J].Dysphagia,2000,15(3):115-121.
[11]王珊珊,顾莹,刘敏,等.口肌生物反馈训练结合常规吞咽康复训练治疗脑卒中后吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2017,39(1):27-29.
[12]张莉,刘畅,李慧敏,等.低频电刺激治疗脑卒中后吞咽障碍的疗效观察[J].实用老年医学,2018,32(5):84-86.
[13]李晓军,张玉梅,郑永强,等.六泉穴解惑刺法对缺血性脑卒中后吞咽障碍患者Hcy及生活质量的影响[J].针灸临床杂志,2016,32(2):48-50.
[14]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍随机对照研究[J].中国针灸,2016,36(4):347-350.
[15]赵妍妍,寇娟,黄娣,等.穴位贴敷配合康复训练对脑卒中后吞咽障碍的效果观察[J].中国康复医学杂志,2012,27(8):771-772.
[16]李同军,于志国,刘旭东,等.推拿结合针刺治疗痉挛性构音障碍的临床疗效观察[J].针灸临床杂志,2017,33(9):27-30.
[17]夏泳,姜敏.穴位贴敷联合中医按摩法对脑梗死恢复期患儿肢体功能障碍的影响[J].中医药导报,2017,23(6):65-68.