基于容积黏度吞咽试验联合训练对脑卒中吞咽障碍患者的影响

  目的  探讨基于容积黏度吞咽试验(V-VST)联合训练对脑卒中吞咽障碍患者的影响，为临床康复训练及治疗提供依据。  方法  选择2020年1月—2021年8月在温州医科大学附属第二医院就诊的100例脑卒中吞咽障碍患者，按照随机数表法将患者随机分为观察组和对照组，各50例。对照组患者均给予对症治疗和常规护理，指导患者进行简单的吞咽功能训练。观察组患者在对照组的基础上给予V-VST试验筛查，根据筛查结果制定摄食训练和吞咽康复训练方案。记录2组患者1个月内的胃管置管时间、住院时间、吸入性肺炎发生率、误吸发生率情况。采用标准吞咽功能评估量表(SSA)评估患者干预前后吞咽功能。比较2组患者洼田饮水试验结果和吞咽障碍治疗效果。  结果  观察组患者胃管滞留时间、住院时间、误吸率、吸入性肺炎发生率均小于对照组(均P < 0.05)。干预前2组患者吞咽功能评分相当，干预后2组患者吞咽功能评分均显著下降，且观察组低于对照组(均P < 0.05)。干预后观察组洼田饮水试验Ⅰ级、Ⅱ级例数多于对照组(P < 0.05)。观察组患者吞咽困难治疗有效率为96.00%(48/50)，高于对照组的74.00%(37/50，χ2=9.490，P=0.002)。  结论  基于容积黏度吞咽试验联合训练能够有效提高脑卒中吞咽障碍患者的治疗效果，缩短住院时间，降低误吸率及吸入性肺炎发生率，有较好的临床应用价值。 

The effect of combined training on patients with dysphagia after stroke based on volume viscosity swallowing test

  Objective  To explore the effect of combined training based on the volume viscosity swallowing test (V-VST) on stroke patients with dysphagia, and to provide a basis for clinical rehabilitation training and treatment.  Methods  A total of 100 stroke patients with dysphagia who were treated in the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to August 2021 were selected and randomly divided into observation group and control group according to the random number table method, with 50 cases in each group. The patients in the control group were given symptomatic treatment and routine care, and the patients were instructed to carry out simple swallowing function training. Patients in the observation group were screened by the V-VST test on the basis of the control group, and the feeding training and swallowing rehabilitation training programs were formulated according to the screening results. The time of gastric tube intubation, hospital stay, incidence of aspiration pneumonia and incidence of aspiration within 1 month of the two groups of patients were recorded. The swallowing function was assessed by the standardized swallowing assessment (SSA) before and after the intervention. The results of the water field drinking test and the treatment effect of dysphagia were compared between the two groups.  Results  The gastric tube retention time, hospitalization time, aspiration rate, and incidence of aspiration pneumonia in the observation group were significantly lower than those in the control group (all P < 0.05). Before the intervention, the swallowing function scores of the two groups of patients were the same. After the intervention, the swallowing function scores of the two groups were significantly decreased, and the observation group was lower than the control group (all P < 0.05). After the intervention, there were more cases of grades Ⅰ and Ⅱ of the water-field drinking test in the observation group than that in the control group (P < 0.05). The effective rate of treatment for dysphagia in the observation group was 96.00% (48/50), which was higher than that in the control group (74.00%, 37/50, χ2=9.490, P=0.002).  Conclusion  Combined training based on V-VST can effectively improve the treatment effect of stroke patients with dysphagia, reduce the rate of aspiration during hospitalization and the incidence of aspiration pneumonia, which has good clinical application value.