针刺治疗假性球麻痹吞咽困难89例

假性球麻痹属于上运动神经元延髓麻痹,常见于两侧半球血管病变,如脑梗死、多发性腔隙性梗塞、脑出血等疾病。临床表现为构音障碍,吞咽困难,饮水呛咳,患者不能进食、进水,出现营养不良。笔者运用针刺治疗假性球麻痹89例,疗效显著,现报道如下。     

针药结合治疗风痰阻络证中风后吞咽障碍患者75例临床观察

目的 观察化痰通咽汤结合针灸治疗中风后风痰瘀阻证吞咽障碍的临床疗效.方法 选取在武汉市第一医院康复医学科住院的证属风痰瘀阻证中风后吞咽障碍患者150例,随机分为对照组和治疗组各75例.治疗组采用针刺结合化痰通咽汤进行治疗,对照组采用针刺治疗,两组均给予神经内科基本治疗和康复治疗,疗程4周,对比临床疗效.结果 治疗后两组洼田饮水试验评分,吞咽功能障碍中医评价量表评分,电视X线透视吞咽功能检查,吞咽困难生活质量测量比较差异均有统计学意义,治疗组优于对照组(P＜0.05).结论 在神经内科基本治疗和康复治疗基础上综合运用化痰通咽汤结合针灸治疗中风后风痰瘀阻证吞咽障碍患者,能提高疗效,值得推广应用.     

覆膜食管支架的临床疗效评价

目的：评价覆膜食管支架的临床疗效。方法在血管造影机的引导下对25例患者置入覆膜食管支架。结果术后25例患者呛咳、吞咽困难等症状得到改善,生活质量明显提高,未见严重并发症。结论置入覆膜食管支架可以安全、有效地治疗食管气管瘘。     

西安地区伴吞咽障碍老年急性脑梗死患者的临床特征及对住院结局的影响

目的 探讨西安地区伴吞咽障碍老年急性脑梗死患者的临床特征以及吞咽障碍对院内结局的影响.方法 通过西安卒中登记研究,纳入西安市4所三级甲等医院收治的1116例老年急性脑梗死患者,根据入院24 h内洼田饮水试验评分分为吞咽良好组(1～2级)1004例和吞咽障碍组(3～5级)112例,比较分析2组的基线临床特征.采用多因素L...     

护理干预预防脑卒中吞咽障碍患者吸入性肺炎效果观察

目的探讨护理干预预防脑卒中吞咽障碍患者吸入性肺炎的效果.方法将180例脑卒中吞咽障碍患者随机分为对照组(84例)和干预组(96例),两组均予神经内科常规治疗及护理,干预组在此基础上给予吞咽功能训练及进食功能训练.入院及住院30 d时比较两组患者吸入性肺炎的发生情况及吞咽康复效果.结果干预组吸入性肺炎发生率显著低于对照组(P<0.05),而吞咽康复总有效率显著高于对照组(P<0.01).结论吞咽功能训练及进食功能训练可有效预防患者吸入性肺炎的发生,明显改善其吞咽障碍.     

针刺治疗脑卒中后假性球麻痹致吞咽困难临床研究

目的:探讨针刺治疗脑卒中后假性球麻痹致吞咽困难的临床疗效。方法:选取60例患者随机分成治疗组与对照组,各30例。两组患者均给予相同的基础治疗,治疗组加用针刺治疗。全部疗程结束后,通过吞咽功能评分,洼田饮水试验前后脉冲血氧饱和度下降值和血清前白蛋白水平测定值3项指标进行统计学分析,了解患者吞咽功能,误吸和营养不良改善状况。结果:治疗组有效率为90.0%,明显优于对照组76.7%(P0.05);吞咽功能评分、洼田饮水试验前后脉冲血氧饱和度下降值和血清前白蛋白水平,两组治疗前后比较,均具有显著性差异(P0.05),治疗后两组比较,差异有统计学意义(P0.05)。结论:针刺治疗脑卒中后假性球麻痹致吞咽困难效果显著,能明显改善患者的吞咽功能,误吸和营养不良状况。     

国产镍钛合金支架治疗食管狭窄

采用国产镍钛合金食管支架置入术治疗食管狭窄24例。全部支架置入术经口腔在X线电透导向下进行，均获成功。患者症状得到缓解，摄食能力有不同程度改善，总有效率达100％。支架置入治疗食管狭窄，简单安全有效，但远期效果尚需进一步观察。     

脑卒中后吞咽障碍康复管理流程构建与应用

目的构建脑卒中后吞咽障碍康复管理流程,评价应用效果。方法通过循证证据检索和专家咨询构建脑卒中后吞咽障碍康复管理流程。按照住院时间将411例初发脑卒中患者分为对照组198例和干预组213例;对照组给予常规康复护理流程;干预组实施脑卒中后吞咽障碍康复管理流程,包括吞咽障碍筛查、吞咽障碍程度判定、摄食风险评估、康复介入及动态评估。结果干预组患者康复介入时间显著短于对照组(P0.01);入院时及脑卒中后1个月,两组吞咽障碍发生率差异无统计学意义(均P0.05),脑卒中后1个月干预组吞咽障碍严重程度及生活质量评分显著优于对照组(均P0.01)。结论应用脑卒中后吞咽障碍康复管理流程能有效缩短脑卒中患者康复介入时间,降低患者吞咽障碍严重程度,提高其生活质量。     

A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer

AimsSelf-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy.Materials and methodsA Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses.ResultsFive of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2–72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6–not reached).ConclusionThe high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.     

Effectiveness of Single Dilation with Maloney Dilator versus Endoscopic Rupture of Schatzki's Ring Using Biopsy Forceps

Current recommendations for treatment of patients with symptomatic Schatzki's ring are based on anecdotal experience or uncontrolled studies. Maloney dilation is the gold standard. We performed a randomized controlled trial to compare the use of a single 52-Fr Maloney dilation versus four quadrant biopsy of Schatzki's ring for relief of dysphagia. The subjects answered standardized dysphagia-related questions on a scale of 0–5 (0 = no dysphagia; 5 = cannot handle secretions). To account for modifications in diet and eating habits, subjects answered 11 question to arrive at a eating/diet score. Patients with Schatzki's ring were randomized into one of the two protocols. Group 1 underwent endoscopic biopsies of the ring, one biopsy in each quadrant. In group 2, the endoscope was taken out, and a single 52-Fr Maloney dilation was performed. Twenty-six patients participated in the study and were followed for up to 15 months. There was no significant difference in age, sex, race, smoking, alcohol abuse, or medication intake between the two groups. Dysphagia score improved by 91% in both groups at three months and 84% and 85% at 12 months in groups 1 and 2, respectively. The eating/diet habit score improved by 78% in both groups. There was one failure in each group, and one recurrence at six months in the dilation group. Fifty-five percent of dilation group and 100% of biopsy group described the procedure as easy. There was no difference in the amount of sedatives used during the procedure or the acid blockers after the procedure. In patients undergoing endoscopy, the superior cost/safety profile of endoscopic biopsy makes it a preferred choice for treatment of Schatzki's ring over bougienage.