多维度康复管理模式在卒中后吞咽障碍患者康复中的应用  

The intervention effect of multidimensional rehabilitation management mode on patients with dysphagia after stroke

作　　者：雷茵 顾琳 严琳[1] 徐涵 高怡 武军 Lei Yin;Gu Lin;Yan Lin;Xu Han;Gao Yi;Wu Jun(Rehabilitation Medicine Department,Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China;Speech Therapy Department,Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China;Department of Radiology,Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China;Rehabilitation Medicine Department,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海市瑞金康复医院康复医学科,200023 [2]上海市瑞金康复医院言语治疗部,200023 [3]上海市瑞金康复医院康复医学放射科,200023 [4]上海交通大学医学院附属瑞金医院康复医学科,200025

出　　处：《神经疾病与精神卫生》2023年第8期570-576,共7页Journal of Neuroscience and Mental Health

基　　金：上海市黄浦区青年医师培养资助计划(2021QN07);上海市卫生健康委员会卫生行业临床研究专项面上项目(202240203)。

摘　　要：目的探讨多维度康复管理模式在卒中后吞咽障碍患者中的应用价值。方法选取2019年12月至2021年10月上海市瑞金康复医院收治的66例卒中后吞咽障碍患者为研究对象,其中对照组35例来自综合康复病区,采用常规综合康复干预方案;观察组31例来自脑病康复病区,在对照组的基础上采用包括多学科协作管理、风险管理和精细化管理3个维度的多维度康复管理模式进行干预。分别于干预前、干预3周后采用洼田饮水试验和吞咽造影检查(VFSS)、渗漏误吸量表(PAS)评价两组患者的吞咽功能,采用功能性经口摄食量表(FOIS)评估患者的进食功能水平,通过患者血清白蛋白水平测定评估营养状态,采用中文版SWAL-QOL评估两组患者的生活质量。结果观察组的吞咽功能康复总有效率为87.1%(27/31),高于对照组的64.6%(26/35),差异有统计学意义(χ^(2)=6.150,P<0.05)。干预后两组患者的VFSS评分和FOIS评分均高于干预前,且干预后观察组的VFSS评分高于对照组[(8.32±1.28)比(7.03±1.86)分],FOIS评分高于对照组[5.0(4.0,6.0)比3.0(1.0,6.0)分],差异有统计学意义(t=3.260,Z=-3.196;均P<0.01)。干预后观察组患者的PAS评分低于对照组[1.0(1.0,1.0)比2.0(1.0,5.0)分],差异有统计学意义(Z=-2.429,P<0.05)。观察组干预后的血白蛋白水平高于干预前[(33.44±3.19)比(30.90±3.34)g/L],差异有统计学意义(t=6.528,P<0.01)。两组患者的中文版SWAL-QOL评分较干预前升高,且干预后观察组的评分高于对照组[135.0(129.0,149.0)比103.0(94.0,136.0)分],差异有统计学意义(Z=-3.023,P<0.01)。结论多维度康复管理模式对保证卒中后吞咽障碍患者的营养需求、改善吞咽功能、提高生活质量具有积极作用。Objective To explore the application value of multidimensional rehabilitation management mode in patients with dysphagia after stroke. Methods A total of 66 patients with dysphagia after stroke in Shanghai Ruijin Rehabilitation Hospital between December 2019 and October 2021 were selected as the subjects. In the control group, 35 cases were from the comprehensive rehabilitation ward, and the routine comprehensive rehabilitation intervention program was adopted. In the observation group, 31 cases were from the encephalopathy rehabilitation ward. On the basis of the control group, the multidimensional rehabilitation management mode including multidisciplinary collaboration, risk management and delicacy management was used for intervention. The swallowing function of both groups was evaluated respectively by Sub-water Test Score, Videofluoroscopic Swallowing Study (VFSS) and Penetration Aspiration Scale (PAS) before and after the 3 weeks' intervention. The functional level of intake of food and liquid was evaluated by Functional Oral Intake Scale (FOIS). Nutritional status was assessed by measuring serum albumin level. The Chinese version of Swallowing-Quality of Life(SWAL-QOL) was used to assess the quality of life. Results The total effective rate in the observation group was 87.1% (27/31), higher than that in the control group 64.6% (26/35), the difference was statistically significant (χ^(2) =6.150, P < 0.05). After the intervention, the VFSS and FOIS scores of the 2 groups were higher than before (P < 0.05). After the intervention, the VFSS score of the observation group was higher than that of the control group[ (8.32±1.28) vs (7.03±1.98) points]. After the intervention, the FOIS score of the observation group was higher than that of the control group [5.0(4.0,6.0) vs 3.0(1.0,6.0) points], and the difference was statistically significant (t=3.260, Z=-3.196;all P < 0.01). After the intervention, the PAS score of the observation group was lower than that of the control group [1.0 (1.0,1.0) vs 2.0 (1.0, 5.0) p

关 键 词：卒中 吞咽障碍 多维度康复管理模式 进食功能 营养 生活质量 

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]