神经源性吞咽障碍伴痉挛性斜颈的临床治疗观察  

The influence of spasmodic torticollis on the clinical prognosis of patients with neurogenic dysphagia

作　　者：郭钢花[1] 王国胜[1] 李哲[1] 

机构地区：[1]郑州大学第五附属医院康复中心,郑州450052

出　　处：《中华物理医学与康复杂志》2012年第9期673-676,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河南省科技攻关计划项目（072102310043）

摘　　要：目的观察痉挛性斜颈对神经源性吞咽障碍患者康复预后的影响及不同治疗方法的疗效比较。方法选取神经源性吞咽障碍患者103例，其中伴有痉挛性斜颈患者82例，采用随机数字表法分为单纯训练组（21例，仅给予常规吞咽康复训练）、药物训练组（21例，给予常规吞咽康复训练及药物治疗）、支持训练组（20例，给予常规吞咽康复训练及一般性支持治疗）及联合治疗组（20例，给予常规吞咽康复训练、药物及一般性支持治疗），余21例无痉挛性斜颈的神经源性吞咽障碍患者则归人无斜颈组（给予常规吞咽康复训练）。于治疗前、治疗2个月对各组患者吞咽功能改善情况进行评定。结果治疗前药物训练组、支持训练组、联合治疗组和单纯训练组吞咽功能均显著低于无斜颈组（P〈0．05）；各组患者分别经2个月治疗后，发现5组患者吞咽功能均较治疗前显著改善（P〈0．05），其中药物训练组、支持训练组、联合治疗组和无斜颈组吞咽功能均显著优于单纯训练组（P〈0．05）；联合治疗组吞咽功能亦显著优于药物训练组及支持训练组（P〈0．05）；联合治疗组和无斜颈组吞咽功能组问差异无统计学意义（P〉0．05）。结论痉挛性斜颈能影响神经源性吞咽障碍患者吞咽功能恢复，对痉挛性斜颈进行治疗可明显提高神经源性吞咽障碍患者吞咽功能。Objective To observe the influence of spasmodic torticollis on the rehabilitation prognoses of patients with neurogenic dysphagia. Methods One hundred and three dysphagic patients were recruited, of which 82 had spasmodic torticollis and 21 did not. The subjects with spasmodic torticollis were divided randomly into a medication therapy group （21 cases） which accepted medication plus swallowing training, a common therapy group （20 cases） accepting common support treatment plus swallowing training, a combined therapy group （20 cases） accepting common support treatment, medication, plus swallowing training as well, and a group of 21 cases accepting only routine rehabilitation therapy （the routine rehabilitation group）. The 21 cases without spasmodic torticollis served as a control group, and they were treated with routine rehabilitative treatment. The swallowing function of all patients was evaluated before and after therapy using videofluoroscopic swallowing study techniques. Results There was no significant difference with regard to the swallowing function among the groups before treat- ment except that the swallowing function of the control group （ without torticollis） was significantly better than that of the other 4 groups. After treatment, swallowing function had improved significantly in all 5 groups. The average improvement in the routine rehabilitation group was, however, significantly less than in the others. After treatment there was no significant difference between the combined therapy group and the no torticollis control group with regard to swallowing function. Conclusions Spasmodic torticollis influences the recovery of swallowing function in dysphagic patients. Therapy for spasmodic torticollis can improve swallowing among dysphagic patients with spasmodic tortieollis.

关 键 词：斜颈 吞咽障碍 评价 

分 类 号：R473.74[医药卫生—护理学]