不同训练方法对环咽肌失弛缓患者食管上段腔内压力的影响  

The effect of the different swallowing training techniques on the pre-swallow peak pressure of upper esophageal sphinctor

作　　者：李哲[1] 王国胜[1] 郭钢花[1] 关晨霞[1] 乐琳[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》2013年第12期972-975,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河南省科技攻关计划项目资助（072102310043）

摘　　要：目的探讨不同训练方法对环咽肌失弛缓患者吞咽前食管上段括约肌（UES）压力及吞咽功能的影响。方法共选取57例脑卒中后环咽肌失弛缓患者，按随机数字表法将其分为常规训练组、球囊扩张组、综合训练组，每组19例。3组患者均给予吞咽电刺激治疗和吞咽功能训练，常规训练组和球囊扩张组在此基础上分别增加喉上提训练和球囊扩张术治疗，综合训练组在电刺激和吞咽功能训练基础上增加喉上提训练及球囊扩张术治疗。治疗前及治疗8周后（治疗后），利用高分辨多通道胃肠功能检测仪对患者吞咽前UES压力进行测定，采用洼田饮水试验和藤岛一郎吞咽障碍分级评定患者的吞咽功能。结果治疗前，3组患者吞咽前UES压力、吞咽障碍评级、洼田饮水试验分级及视频透视吞咽检查（VFSS）结果比较，差异均无统计学意义（P〉0．05）。与组内治疗前比较，球囊扩张组治疗后吞咽前UES压力[（266．4±82．7）mmHg]和综合训练组治疗后吞咽前UES压力[（269．5±83．2）mmHg]均显著提高（P〈0．05），且综合训练组治疗后吞咽前UES压力高于球囊扩张组（P〈0．05）。治疗后，球囊扩张组和综合训练组患者吞咽障碍分级、洼田饮水试验分级及VFSS结果均较治疗前有所好转（P〈0．05），且综合训练组患者上述指标较球囊扩张组改善更为显著（P〈0．05）。结论在吞咽电刺激和功能训练基础上增加球囊扩张术和喉上提训练，可有效提高环咽肌失弛缓患者吞咽前的UES压力，降低UES张力，对其康复治疗具有重要意义。Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter （UES） in patients with post-stroke cricopharyngeal aehalasia, and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis. Methods Fifty-seven stroke patients with cricopha- ryngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallo- wing training group with 19 patients in eachp. All the three groups accepted routine swallowing training. In addtion, the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training, respectively, while the combined training group accepted larynx elevation training and balloon dilation training simultaneously. The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointesti- nal dynamical detection system （PC Polygraf HR, CTD-synectics, Sweden） before and after 8 weeks of treatment. The swallowing function was assessed using swallowing function classification and water swallowing test. Results Before treatment, there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure, swalh）wing function classification, water swallowing test and VFSS （P 〉 0.05 ）. After treatment, pre-swallow peak UES pressure, swallowing function classification, water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment （P 〈 0.05 ） , and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group （P 〈 0.05）. Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase preswallow peak UES pressure, decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia, which is of great importance for their recovery.

关 键 词：环咽肌失弛缓症 康复训练 吞咽障碍 生物力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]