生物反馈刺激联合吞咽康复训练对脑卒中后吞咽障碍的影响

目的观察生物反馈刺激联合吞咽康复治疗对卒中后吞咽障碍的影响。方法将112例脑卒中吞咽困难患者随机分为康复训练组、生物反馈刺激结合康复训练组(联合治疗组)。对两组患者治疗前后吞咽功能动态改变以洼田饮水实验分级法进行测评。结果两组治疗后洼田饮水实验分级均有明显提高(P<0.01),联合治疗组吞咽障碍有效率高于吞咽康复训练组(P<0.05)。结论生物反馈刺激联合吞咽康复治疗能明显改善吞咽功能,对改善卒中后吞咽障碍有协同作用。     

醒脑汤联合头针治疗脑卒中恢复期吞咽障碍的效果分析

目的探讨醒脑汤联合运动头针法治疗脑卒中恢复期患者吞咽障碍的临床效果。方法选取2017年2月至2018年4月在我院住院治疗的脑卒中后吞咽障碍患者94例为研究对象,根据入院先后进行编号,将单号入院患者设为对照组,将双号入院患者设为观察组,每组47例。对照组患者进行进食及吞咽功能康复训练;观察组患者在此基础上给予醒脑汤联合头针治疗,疗程4周。比较两组患者治疗前后吞咽功能(洼田饮水试验分级)及吞咽障碍生活质量量表(SWAL-QOL)评分。结果治疗前,两组患者洼田饮水试验分级比较差异无统计学意义(P0.05);治疗4周后,两组患者洼田饮水试验2、3级占比显著升高,4、5级占比显著降低,观察组患者洼田饮水试验分级显著优于对照组,差异有统计学意义(P0.05)。治疗前,两组患者的SWAL-QOL量表各维度评分比较差异无统计学意义(P0.05);治疗4周后,两组患者SWAL-QOL量表吞咽症状维度、吞咽相关维度、其他症状维度评分均显著升高,观察组患者的各维度评分均高于对照组,差异有统计学意义(P0.05)。结论醒脑汤联合头针治疗脑卒中恢复期患者吞咽障碍临床疗效显著,有利于促进患者康复。     

电针配合常规康复训练治疗脑卒中后吞咽障碍的疗效观察

目的 探讨电针配合常规康复训练对脑卒中后吞咽功能的影响.方法 60例脑卒中后吞咽障碍的患者随机分为观察组(32例)和对照组(28例).对照组给予吞咽治疗仪、基础吞咽功能训练和进食训练,观察组在对照组治疗方法的基础上给予电针治疗.并以治疗前后洼田氏咽水试验分级作为观察指标.治疗30 d后观察疗效.结果 治疗后观察组的洼田氏咽水试验分级低于对照组(P<0.05).结论 中西医结合的康复方法在提高脑卒中患者吞咽功能方面有一定的优势.     

综合康复治疗脑卒中吞咽障碍的疗效分析

目的探讨综合康复治疗对脑卒中吞咽障碍病人吞咽功能的临床疗效。方法将84例脑卒中后吞咽障碍病人随机分为治疗组和对照组,各42例。对照组单纯采用常规药物治疗,治疗组在常规药物治疗基础上应用综合康复治疗,治疗时间为8周。分别于治疗前及治疗后2周、4周、6周、8周利用标准吞咽功能评估(SSA)表进行吞咽功能床旁评估,并记录吸入性肺炎发生情况。结果综合康复治疗2周,SSA评分差异无统计学意义(P0.05);4周、6周、8周时疗效显著,SSA评分比较差异有统计学意义(P0.05)。吸入性肺炎发生率差异无统计学意义(P0.05)。结论综合康复治疗对脑卒中后吞咽障碍病人的吞咽功能有明显疗效,可在临床工作应用和推广。     

舌肌康复器联合吞咽康复治疗脑卒中病人口腔期吞咽障碍的疗效观察

目的探讨舌肌康复器联合吞咽康复对脑卒中病人口腔期吞咽障碍的疗效。方法选取吞咽障碍口腔期病人90例,随机分为3组,各30例。对照组给予常规神经内科治疗;吞咽康复训练组在对照组基础上再予吞咽康复治疗;联合治疗组在吞咽康复训练组基础上联合舌肌康复器治疗,比较3组临床疗效。结果吞咽康复训练组和联合治疗组均能改善吞咽障碍,但联合治疗组疗效优于对照组(P0.05)。结论舌肌康复器联合吞咽康复治疗对脑卒中后口腔期吞咽障碍有显著疗效,可有效改善吞咽功能并缩短治疗时间,且联合治疗疗效优于单一康复治疗。     

脑梗死后吞咽障碍的康复治疗

目的探讨脑梗死吞咽障碍病人的康复治疗。方法对58例脑梗死吞咽障碍病人随机分为康复治疗组29例(简称康复组)和神经内科常规治疗组29例(简称对照组),对康复组进行系统康复训练治疗。结果康复组吞咽评价平均得分和吞咽功能康复程度均明显优于对照组(P<0.01)。结论对脑卒中吞咽障碍病人进行早期吞咽功能训练,使病人恢复经口吞咽进食,促进疾病的整体康复,提高了病人的生活质量。     

早期干预对急性脑梗死后吞咽障碍患者营养状况及ADL的影响

目的探讨早期不同干预措施对急性脑梗死所致吞咽障碍患者的吞咽能力、营养状况及日常生活活动能力（ADL）的影响。方法将100例急性脑梗死后吞咽障碍患者随机分为综合治疗组（康复训练联合针灸治疗）、康复训练组、针灸治疗组及常规药物组各25例,于治疗前、治疗2周后分别采用吞咽电视检查（VFSS）评价吞咽障碍程度,检测血清白蛋白、血红蛋白、总淋巴细胞计数,采用Barthel指数分级法评价ADL。结果治疗2周后,综合治疗组吞咽能力改善有效率优于其他3组（P〈0.05）;4组血清白蛋白、血红蛋白、总淋巴细胞计数均较治疗前下降（P〈0.05）,但综合治疗组优于其他3组（P〈0.05）;2周后综合治疗组Barthel指数分级改善均优于其他3组（P〈0.05）。结论急性脑梗死后吞咽障碍经早期康复训练联合针灸治疗,能明显改善吞咽功能,缓解营养不良恶化,促进患者ADL的恢复。     

下颌收拢抗阻力运动在老年脑梗死后吞咽障碍者中的应用效果

目的评价下颌收拢抗阻力运动(CTAR)对老年脑梗死后吞咽障碍患者的治疗效果和心理状态的影响。方法应用随机数字表法将90例老年脑梗死后吞咽障碍者分成CTAR组、Shaker组和对照组。实验前3组患者通过吞咽障碍分级评价和抑郁自评量表(SDS)评价后,对各组患者均进行神经内科常规治疗,其中CTAR组在常规治疗基础上,结合CTAR治疗,Shaker组结合Shaker运动训练。并分别经过2、4、6 w的治疗和康复后再次评价吞咽功能。同时,经康复训练6 w后再次进行SDS评定。结果治疗前各组老年患者吞咽障碍的程度和SDS得分无显著差异(P>0.05),治疗后各组患者吞咽障碍均有不同程度改善,其中2~4 w患者吞咽功能恢复最为明显。CTAR组疗效显著优于Shaker组和对照组(P<0.05)。治疗6 w后CTAR组SDS评分明显低于Shaker组和对照组(P<0.05)。结论对老年脑梗死后吞咽功能障碍者在常规治疗的基础上结合CTAR,可以有效提高其吞咽功能,减轻心理负担、改善抑郁状态。     

护理干预对脑卒中吞咽障碍患者家庭康复的影响

目的探讨家庭康复护理对脑卒中吞咽障碍患者吞咽功能恢复的影响。方法将30例脑卒中吞咽障碍患者随机分为干预组16例和对照组14例。用才藤7级分类法作为评价标准,对干预组患者进行以吞咽功能训练为主的家庭康复护理。对照组采用神经科常规护理治疗。结果两组患者4周康复护理训练后评分间差异有统计学意义（P〈0．01）。干预组治疗后评分较治疗前明显改善,并且与对照组比较有明显差异（P〈0．01）。干预组和对照组显效率和有效率分别为50％、100％和0、64．3％。结论对脑卒中吞咽障碍患者进行以吞咽功能训练为主的家庭康复护理干预。能显著改善患者的吞咽功能。     

脑卒中吞咽障碍合并认知功能缺损的康复训练

目的:探讨脑卒中吞咽障碍合并认知功能缺损康复训练的方法及疗效。方法:60例脑卒中吞咽障碍合并认知功能缺损的患者,随机分为两组,对照组给予吞咽功能训练并行针灸治疗;治疗组在对照组治疗方法基础上进行认知功能的评定、训练和心理疏导。结果:治疗组经认知功能训练后MMSE评分有显著提高(P<0.01),治疗后田洼氏评分明显高于对照组(P<0.05)。结论:对于脑卒中吞咽障碍合并认知功能缺损的患者,进行康复训练的同时,积极进行认知功能的训练和心理疏导,更利于吞咽功能障碍的恢复。     

Combined Neuromuscular Electrical Stimulation (NMES) with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Traditional Swallowing Rehabilitation in the Treatment of Stroke-Related Dysphagia

Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. Thirty-two patients with moderate to severe dysphagia poststroke (≥3 weeks) were recruited. Patients received 12 sessions of NMES for 1 h/day, 5 days/week within a period of 2–3 weeks. FEES was done before and after NMES for evaluation and to guide dysphagic therapy. All patients subsequently received 12 sessions of traditional swallowing rehabilitation (50 min/day, 3 days/week) for 4 weeks. Primary outcome measure was the Functional Oral Intake Scale (FOIS). Secondary outcome measures included clinical degree of dysphagia, the patient’s self-perception of swallowing ability, and the patient’s global satisfaction with therapy. Patients were assessed at baseline, after NMES, at 6-month follow-up, and at 2-year follow-up. Twenty-nine patients completed the study. FOIS, degree of dysphagia, and patient’s self-perception of swallowing improved significantly after NMES, at the 6-month follow-up, and at the 2-year follow-up (p < 0.001, each compared with baseline). Most patients reported considerable satisfaction with no serious adverse events. Twenty-three of the 29 (79.3 %) patients maintained oral diet with no pulmonary complications at 2-year follow-up. This preliminary case series demonstrated that combined NMES, FEES, and traditional swallowing rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.     

功能训练结合高压氧治疗脑卒中后吞咽障碍患者的临床观察

目的探讨功能训练结合高压氧治疗对脑卒中后吞咽障碍患者吞咽困难改善情况。方法将120例脑卒中后吞咽困难患者随机分为试验组和对照组,每组60例,试验组给予高压氧结合吞咽功能训练、针灸及中医中药治疗,对照组给予针灸及中医中药治疗。分别在治疗后的1、2、3、4周进行疗效的判断。结果试验组患者症状改善明显优于对照组,2组在4个时间点的差异均有统计学意义(P0.05)。结论功能训练结合高压氧治疗脑卒中后吞咽障碍是一种有效的方法。     

项丛刺疗法配合吞咽康复训练治疗脑中风后吞咽障碍

目的：观察项丛刺疗法配合吞咽康复训练治疗缺血性脑梗死后吞咽障碍患者的疗效。方法选择脑中风合并吞咽障碍患者78例（男42例,女36例）,随机分为两组,每组39例。治疗组：风池、天柱、完骨、风府、哑门、廉泉、夹廉泉、金津、玉液,阿司匹林100 mg每日一次口服;同时配合吞咽障碍康复治疗。对照组：银杏叶提取物注射液600 mg＋生理盐水250 mL每日一次静脉输注,阿司匹林100 mg每日一次口服;同时配合吞咽障碍康复治疗。各组疗程为2周,观察两组的治疗效果。结果治疗组临床基本痊愈率28.2%（11例）,显效率25.7%（10例）,有效率33.3%（13例）,总有效率为87.2%（34例）。对照组临床基本痊愈率为10.3%（4例）,临床显效率20.5%（8例）,临床有效率28.2%（11例）,总有效率为59%（23例）。两组临床痊愈率、总有效率比较有统计学意义（P〈0.05）。结论项丛刺疗法配合吞咽康复训练治疗脑中风后吞咽障碍有明显疗效。     

导管球囊扩张术结合用力吞咽法治疗老年环咽肌功能障碍的临床研究

目的 探讨导管球囊扩张术结合用力吞咽法应用于老年环咽肌功能障碍病人的疗效.方法 选择经视频吞咽造影检查(VFSS)明确诊断为环咽肌功能障碍的老年病人32例,按入院顺序分为研究组和对照组,每组各16例.研究组给予导管球囊扩张术结合用力吞咽法治疗,对照组给予常规吞咽康复治疗,2组均辅以神经肌肉电刺激,分别在治疗前和恢复经口...     

针灸加康复训练治疗中风后吞咽障碍33例

目的 探讨早期针灸加康复训练对中风后吞咽障碍患者吞咽功能恢复的影响.方法 将中风住院患者63例随机分为治疗组和对照组.治疗组采用针灸加现代吞咽功能康复训练,对照组采用现代吞咽功能康复训练.以洼田氏饮水实验评价法进行功能评定.结果 治疗后治疗组吞咽功能恢复得更好,且并发症的发生率明显降低,差异有统计学意义(P<0.01).结论 中风后吞咽障碍患者宜早期针灸结合吞咽功能康复训练.     

改良饮食模式对脑卒中后吞咽困难患者的效果评价

目的 分析改良饮食模式对脑卒中后吞咽困难患者的临床效果,为其远期预后康复治疗提供实践性指导.方法 选取2010年3月-2012年9月我院收治的脑卒中后吞咽困难患者60例,利用随机数字表法将其分为研究组和对照组,各30例.对照组采取常规饮食模式;研究组根据患者吞咽困难程度采取改良饮食模式.结果 治疗前,两组患者饮水评级比较,差异无统计学意义（P＞0.05）;治疗后第4周末及第10周末,研究组饮水评级优于对照组（P＜0.05）.治疗后第4周末和第12周末,研究组吸入性肺炎发生率均低于对照组（P＜0.05）.结论 改良饮食模式对于脑卒中后吞咽困难患者是一项行之有效的干预方案,能够促进患者病情预后,提高其吞咽反射能力.     

Radiation enhancement of laser palliation for malignant dysphagia: a pilot study.

Laser therapy offers rapid relief of dysphagia for patients with cancers of the oesophagus and gastric cardia but repeat treatments are required approximately every five weeks to maintain good swallowing. To try to prolong the treatment interval, 22 elderly patients were given additional external beam radiotherapy. Nine had squamous cell carcinoma and 13 adenocarcinoma: five had documented metastases. Six received 40 Gy and 16,30 Gy in 10-20 fractions. A 'check' endoscopy was performed three weeks after external beam radiotherapy. Dysphagia was graded from 0-4 (0 = normal; 4 = dysphagia for liquids). The median dysphagia grade improved from 3 to 1 after laser treatment. This improvement was maintained in the 30 Gy group but there was a noticeable deterioration in three of those who had received the higher radiation dose. A lifelong dysphagia grade of 2 or better was enjoyed by 14 of 16 patients in the 30 Gy group but only two of six in the 40 Gy group. The dysphagia controlled interval was 9 weeks (median) after check endoscopy and subsequent endoscopic procedures were required every 13 weeks to maintain good swallowing. There were no endoscopy related complications. Combined treatment is a promising approach for reducing the frequency of endoscopic treatments. The 30 Gy dose seems more appropriate and may prolong survival. A randomised study to test these conclusions is in progress.     

康复治疗对脑卒中后吞咽障碍的临床效果研究

目的：探讨综合康复治疗对急性脑卒中后吞咽障碍的临床治疗效果。方法：选择我院自2011年6月到2012年6月收治的78例急性脑卒中后吞咽障碍的患者为研究对象,随机分为Vitalstim 电刺激配合吞咽训练（康复治疗组）组及传统吞咽训练（常规训练组）组,每组各39例,分别于治疗前后应用洼田氏饮水试验,观察比较治疗效果并进行统计学分析。结果：康复治疗组的总有效率显著高于常规训练组（92.3％比74.3％,χ2＝4.191, P＝0.041）;康复治疗组的吞咽功能评分平均下降幅度显著高于常规训练组[（2.0±0.5）分比（1.1±0.6）分,t＝5.284, P＝0.032]。结论：综合康复训练能够显著改善脑卒中所导致的吞咽障碍。     

Study on optimization and evaluation system of traditional Chinese medicine rehabilitation program for swallowing disorder after stroke

Background:Acupuncture has a long history in China and is currently widely used in clinical practice. However, there is no large sample data confirming the effectiveness of acupuncture in treating stroke and its sequelae. This article presents a study protocol for a multicenter, randomized, controlled trial for evaluating the efficacy of acupuncture in treating post-stroke dysphagia.Methods/design:A randomized controlled trial will be conducted in three hospitals in Heilongjiang, Changchun, and Beijing. A total of 252 patients with post-stroke swallowing ability will be randomly divided into two groups; specifically, the experimental group, which will receive acupuncture treatment, and the control group, which will undergo rehabilitation training for 2 weeks. The main results will be evaluated using the standard swallowing function scale, videofluoroscopic swallowing examination, and functional magnetic resonance imaging. The secondary observation indexes will include surface electromyography signal analysis and the modified Barthel index. Measurements will be obtained before treatment, as well as 1 week, 2 weeks, and 1 month after treatment.Discussion:This trial could clarify the effectiveness of acupuncture in stroke; moreover, it will determine whether acupuncture can improve swallowing function.Trial registration:Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000030994.     

Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia

Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.