脑梗死后认知-情感、感觉缺损对吞咽功能恢复的影响

目的：探讨认知功能缺损、感觉障碍对脑梗死伴吞咽功能障碍并进行吞咽功能训练的患者吞咽功能恢复的影响.方法：34例脑梗死并发摄食-吞咽功能障碍患者,根据MMSE认知功能评定将患者分为吞咽功能障碍合并认知功能缺损组16例（A组）,单纯吞咽功能障碍组18（B组）.B组患者给予吞咽功能训练并行针灸治疗,A组在B组治疗方法的基础上进行认知功能的评定、训练和心理疏导.结果：治疗前洼田氏评分A组与B组比较差异有显著性意义（P＜0.05）,1个月后两组吞咽评定与自身治疗前相比差异有显著性意义（P＜0.05）,但两组间洼田氏评分比较差异无显著性意义（P＞0.05）.治疗前A组的颜面失用/流涎、失语、口腔感觉程度与B组相比差异有显著性意义（P＜0.05）;A组在认知功能训练后MMSE评定与自身治疗前相比有明显提高（P＜0.05）,治疗前后认知功能评分与吞咽障碍等级均呈负相关（相关系数分别为：-0.650和-0.51）.结论：脑梗死后认知功能缺损的存在可加重吞咽功能障碍的程度,认知功能的改善可促进吞咽功能的恢复.

The effect of cognitive-sentiment and sensorium impairment on swallowing functional recovery after stroke

Objective: To assess the effect of cognitive-sentiment and sensorium impairment on the outcomes of training for swallowing function in patients with dysphagic stroke. Method: Thirty four patients with dysphagic stroke were divided into 2 groups on the basis of MMSE score, in which 16 patients(group A) are dysphagia complicating cognition functional impairment and 18 patients(group B) were just swallowing functional disturbance. All patients accepted treatments including swallowing functional training and acupuncture therapy. Moreover, cognitive-sentiment functional training and psycho therapy were applied for group A. Result:Before treatments, TIANWASHI scores and level of facial apraxia drooling, meal duration, logagnesia and oral sense in group A and group B were different significantly (P<0.05). After 1 month treatments , TIANWASHI scores in two groups were all improved obviously compared to pre-therapy (P<0.05), but no difference was found between them(P>0.05). The MMSE score of group A were raised significantly after cognitive-sentiment functional training (P<0.05). The analysis of correlation showed that the score of cognitive function and the level of dysphagia were negative correlation (r=-0.650 and -0.51). Conclusion:After cerebral infarction, the degree of swallowing handicap are aggravated by cognitive impairment, while the amelioration of cognitive function would facilitate the recovery of swallowing function.