朱海霞

[摘要] 目的 观察吞咽治疗的早期干预时间对脑卒中后吞咽困难恢复的影响。 方法 选取2012年4月～2014年12月内蒙古医科大学附属医院康复科收治的108例首次发病的急性脑卒中且合并吞咽障碍的患者为研究对象，采用随机数字表法将其分为三组：脑卒中3 d后进行干预治疗的A组（n = 36），脑卒中2周后进行干预治疗的B组（n = 36）以及脑卒中1个月后进行干预治疗的C组（n = 36）组。干预治疗2个月后，采用饮水实验及吞咽前后血氧饱和度、吸入性肺炎发生率评价三组患者康复治疗后的疗效。结果 洼田实验结果显示，A组与B组中Ⅰ、Ⅱ级者多于C组，差异有统计学意义（P < 0.05）。三组患者均在饮水实验后表现出血氧饱和度降低，但组间差异无统计学意义（P > 0.05）。住院治疗期间A组吸入性肺炎发生率为5.56%，明显低于B组及C组（16.67%、38.89%），差异均有统计学意义（P < 0.05）。 结论 尽早开展综合康复治疗对脑卒中后吞咽困难恢复更加有效。

[关键词] 脑卒中；吞咽困难；早期干预；综合康复治疗

[中图分类号] R743 [文献标识码] A [文章编号] 1674-4721（2016）10（c）-0166-04

[Abstract] Objective To observe the effects of onset time of swallowing therapy on recovery from dysphagia following stroke. Methods One hundred and eight patients who due to acute stroke in the first time and concurrent dysphagia disease from April 2012 to December 2014 in the Department of Rehabilitation of the Affiliated Hospital of Inner Mongolia Medical University were selected as the study objects. Patients were divided into three groups according to random number table： group A was given intervention treatment 3 days after stroke （n = 36）， group B was given intervention treatment 2 weeks after stroke （n = 36）， group C was given intervention treatment 1 month after stroke （n = 36）. And then 3 groups received comprehensive rehabilitation intervention treatment in 3 days， 2 weeks and 1 month after stroke respectively. After 2 months， the effect of rehabilitation treatment was evaluated through the Watian drinking water test， the levels of oxygen saturation before and after swallowing and the incidence of aspiration pneumonia. Results The Watian drinking water test results showed that， patients of grade Ⅰ and Ⅱ in the group A and B was more than the group C， the difference was statistically significant （P < 0.05）. The Watian drinking water test showed that， three groups presented the reducing of oxygen saturation， but the difference was not statistically significant between groups （P > 0.05）. Incidence of aspiration pneumonia of group A was 5.56%， was lower than those of the group B （16.67%） and group C （38.89%）， and the differences were statistically significant （P < 0.05）. Conclusion Early interventions for dysphagia in stroke have more effective effect in recovery from dysphagia.

[Key words] Stroke； Dysphagia； Early intervention； Comprehensive rehabilitation treatment

吞咽是一种复杂的，处于消化第一阶段的受中枢神经系统支配与调节的口咽部神经肌肉运动。吞咽动作的完成涉及到大脑的多个领域的一系列自主和非自主肌肉收缩运动[1-2]。口咽吞咽困难是一个在脑卒中患者中普遍存在的并发症，发病率为45%～55%，但由于不同的研究所采用的吞咽困难定义、评估吞咽功能的起始点及方法、脑卒中类型的不同而导致脑卒中后口咽吞咽困难发病率报道不尽相同[3-5]。吞咽困难会加重脑卒中患者的医疗并发症，如吸入性肺炎、焦虑等社会心理及经济负担[6-7]。因此，临床实践中一直非常重视脑卒中后患者的吞咽困难问题的护理及治疗工作。……