在电视X线透视吞咽功能检查指导下进行治疗性进食结合吞咽训练对脑卒中后吞咽障碍患者功能的影响

目的:探讨在电视X线透视吞咽功能检查(VFSS)指导下进行治疗性进食结合吞咽训练对脑卒中后吞咽障碍的疗效。方法:选取脑卒中后留置胃管的吞咽障碍患者60例，随机分为对照组和观察组各30例，2组入院后都进行VFSS,对照组给予常规吞咽训练，观察组给予吞咽训练后进行治疗性进食，每周5d,共3周。2组患者分别于治疗前后进行洼田饮水试验(WST),渗漏-误吸分级(PAS)及功能性经口摄食评估(FIOS),并比较2组患者拔管率、患者出院后咳嗽咳痰情况。结果:治疗前，2组患者WST、PAS、FIOS结果比较差异无统计学意义，治疗3周后，对照组WST、PAS分级情况改善(P<0.01,0.05),FIOS等级无明显变化；观察组各项评分较治疗前均有改善(均P<0.01),与对照组相比，观察组3项评估指标、拔管率均有显著改善(均P<0.01),出院1个月后咳嗽咳痰情况有显著改善(P<0.01)。结论:在VFSS指导下进行治疗性进食结合吞咽训练能显著改善脑卒中后吞咽障碍患者的吞咽功能。

Effect of therapeutic eating combined with swallowing training under the guidance of video fluoroscopic swallowing study on the function of patients with dysphagia after stroke

Objective: To investigate the effect of therapeutic eating combined with swallowing training on dysphagia after stroke under the guidance of video fluoroscopic swallowing study (VFSS). Methods: A total of 60 patients with dysphagia after stroke with indwelling gastric tube admitted to Rehabilitation Medical Center of Hubei Hospital of Integrated Traditional and Western Medicine from March 2021 to March 2022 were selected and divided into control group (30 cases) and experimental group (30 cases) according to a random number table. Both groups received VFSS after admission. The control group received routine swallowing training, and the experimental group received therapeutic eating after swallowing training. The patients were treated 5 days in a week for 3 weeks. The data of the water swallow test (WST), the penetration-aspiration scale (PAS) and the functional oral intake scale (FIOS) were recorded. The data were collected before and after treatment, and the extubation rates of the two groups, as well as the cough and sputum of the patients after the discharge were analyzed. Results: There were no significant differences in WST, PAS and FIOS levels before treatment between two groups (P>0.05). After 3 weeks of intervention, there were differences in WST and PAS level (P<0.01), but there were no significant changes in FIOS level in the control group. Scores in the experimental group were significantly improved as compared with those before treatment (P<0.01). As compared with the control group, WST, PAS and FIOS levels and extubation rate were significantly increased, and the cough and expectoration were significantly improved one month after discharge in the experimental group (P<0.01). Conclusion: Therapeutic eating combined with swallowing training under the guidance of VFSS can significantly improve the dysphagia of patients after stroke.