电刺激联合吞咽康复训练治疗卒中后吞咽障碍的疗效及卒中后肺炎发生率的观察

目的观察经皮电刺激联合吞咽康复治疗对卒中后吞咽障碍的疗效以及卒中后肺炎发生率的影响。方法将脑卒中后吞咽障碍患者463例分为3组,康复训练组(n=188)综合应用直接治疗措施+间接治疗措施对患者进行吞咽康复治疗;联合治疗组(n=196)在上述吞咽康复的基础上应用Vocastim-Master吞咽治疗仪经皮电刺激法治疗,一般治疗组(n=79)进行一般卒中康复治疗。统计治疗前及治疗后3周吞咽评分、肺炎发生率,进一步随访出院后3个月内新肺炎发生率。结果经过3周的治疗,联合治疗组吞咽障碍的有效率(81.1%)高于康复训练组(72.3%)及一般治疗组(43.0%)(P<0.05,P<0.01),康复训练组高于一般治疗组(P<0.01);联合治疗组3周内肺炎发生率(12.8%)低于康复训练组(20.2%)及一般治疗组(30.1%)(P<0.05,P<0.01),联合治疗组及康复训练组出院后3个月新发肺炎的患者均明显低于一般治疗组(分别为5.1%、3.7%和12.6%,P<0.05,P<0.01)。结论电刺激法联合吞咽康复治疗能明显改善吞咽功能,同时也可以减少急性期和慢性期的肺炎发生率。

Therapeutic effect of electrical stimulation and rehabilitative on acute stroke patients with dysphagia and post-stroke pneumonia

Objective To observe the effect of combining transcutaneous electrical stimulation and rehabilitative treatment on dysphagia and post-stroke pneumonia(PSP) in acute stroke patients.Methods 463 patients with post-stroke dysphagia were divided into 3 groups.Rehabilitative treatment group(RTG) enrolled 188 acute stroke patients with dysphagia, they were received routine direct and indirect rehabilitative treatment;the combination of transcutaneous electrical stimulation and rehabilitative treatment group(TESRG) enrolled 196 acute stroke patients with dysphagia,they were received routine rehabilitative treatment,and Voeastim-Master transcuetaneous electrical stimulation,normal treatment group(NTG) enrolled 79 acute stroke patients with dysphagia;they were received routine treatment without direct/indirect rehabilitative treatment or Voeastim-Master transcuetaneous electrical stimulation.Three groups were treated for 3 weeks.The dysphagia ability,incidence of pneumonia before and after treatment in 3 weeks and after 3 months were observed and analyzed.Results After 3 weeks,the improve rate of dysphagia in TESRG(81.1%,159/196) was higher than that in RTG(72.3%,136/188,P < 0.05) and in NTG(43.0%,34/79,P <0.01),and improvement of dysphagia ability in RTG was higher than in NTG(P < 0.01).Pneumonia incidence in TESRG(12.8%,25/196) was lower than that in RTG(20.2%,38/188,P <0.05) and NTG(30.1%,24/79,P < 0.01).After 3 months follow-up,pneumonia incidence in RTG and TESRG were lower than that in NTG(5.1%,3.7%and 12.6%,P <0.05,P <0.01,respectively).Conclusion The combination of transcuetaneous electrical stimulation and rehabilitative treatment can improve the dysphagia recovery and lower the incidence of pneumonia in stroke patients with dysphagia.