综合吞咽干预对脑卒中后阻塞性睡眠呼吸暂停合并吞咽障碍患者影响的分析  

Effects of comprehensive deglutition intervention on patients with obstructive sleep apnea complicated with dysphagia after stroke

作　　者：张晓敏 张丽霞 钱苏荣[3] 胡翠琴 贾瑞冬 张翎 李向荣 言丽香[5] 张艳[5] 章金荣 王彤 ZHANG Xiaomin;ZHANG Lixia;QIAN Surong(The First Clinical Medical College of Nanjing Medical University,Nanjing,210029)

机构地区：[1]南京医科大学第一临床医学院,江苏南京210029 [2]江苏省省级机关医院康复医学科 [3]南京医科大学附属苏州医院康复中心 [4]南京医科大学第一附属医院康复医学中心 [5]江苏省常州市德安医院康复中心

出　　处：《中国康复医学杂志》2020年第4期404-409,共6页Chinese Journal of Rehabilitation Medicine

基　　金：江苏省科技厅社会发展计划(BE2017752)。

摘　　要：目的:分析综合吞咽干预能否改善脑卒中后阻塞性睡眠呼吸暂停(OSA)合并吞咽障碍患者的功能。方法:共有40例脑卒中后OSA患者纳入本研究,其中男性32例,女性8例,采用随机数字表法将其分为试验组(n=20)及对照组(n=20)。两组患者均接受吞咽护理,试验组在此基础进行综合吞咽干预(包括吞咽训练、神经肌肉电刺激治疗和发声训练)。分别在干预前、干预4周时对这些患者进行评定。使用多导睡眠监测仪(PSG)诊断脑卒中患者是否患有OSA并评价其严重程度;使用洼田饮水试验、Gugging吞咽功能评估(GUSS)、吞咽造影检查(VFSS)评价患者是否有吞咽障碍及其严重程度。结果:干预4周后试验组GUSS、VFSS评分较前提高,差异具有显著性意义(P<0.01;P<0.05),但对照组GUSS、VFSS评分无明显提高,差异无显著性意义(P>0.05);干预4周后试验组AHI、ODI、平均SaO2较前均明显改善,差异具有显著性意义(P<0.01,P<0.05,P<0.01),但对照组各项指标均无明显改善,差异无显著性意义(P>0.05)。结论:综合吞咽干预不仅能够改善脑卒中后吞咽障碍,还能改善脑卒中后OSA。Objective:To analyze whether comprehensive deglutition intervention can improve the function of patients with obstructive sleep apnea(OSA)complicated with dysphagia after stroke.Method:A total of 40 patients with OSA after stroke were included in this study,including 32 males and 8 females.They were divided into the experimental group(n=20)and the control group(n=20)by random number table method.Patients in both groups received swallowing care,and the experimental group received additional comprehensive swallowing training(including swallowing training,neuromuscular electrical stimulation therapy and vocal training).Patients were evaluated before and 4 weeks after intervention.Patients after stroke were diagnosed with OSA using polysomnography(PSG)and evaluated for severity.Patients after stroke were diagnosed with dysphagia using Kubota’water drinking test,Gugging swallowing function assessment(GUSS)and videofluoroscopic and evaluated for severity.Result:After 4 weeks of intervention,the GUSS and VFSS scores of experimental group were higher than before,and the difference was statistically significant(P<0.01;P<0.05).However,the GUSS and VFSS scores of control group were not higher than before,and the difference was not statistically significant(P>0.05);After 4 weeks intervention,the PSG indexes in the control group didn't significantly improve,and the difference was not statistically significant(P>0.05).The AHI,ODI and average SaO2 significantly improved in the experimental group after 4 weeks of intervention,and the difference was statistically significant(P<0.05).Conclusion:Comprehensive deglutition intervention can not only improve dysphagia after stroke,but also improve OSA after stroke.

关 键 词：综合吞咽干预 阻塞性睡眠呼吸暂停 脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]