早期肺功能康复联合个体化吞咽训练对脑卒中气管切开伴吞咽障碍患者咽部残留与误吸的影响  

Effect of early pulmonary function rehabilitation combined with individualized swallowing training on pharyngeal residual and aspiration in patients with dysphagia after stroke tracheotomy

作　　者：祝飞虹[1] 吴梦媛[1] 朱伟新 ZHU Fei-hong;WU Meng-yuan;ZHU Wei-xin(Jinhua Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院,浙江金华321000 [2]金华市婺城区人民医院,浙江金华321000

出　　处：《医师在线》2023年第12期65-68,共4页Journal of Doctors Online

基　　金：金华市科技计划项目(2021-4-118)。

摘　　要：目的观察早期肺功能康复联合个体化吞咽康复训练对脑卒中气管切开伴吞咽障碍患者咽部残留与误吸的影响。方法选取脑卒中气管切开伴吞咽障碍患者120例,按随机数字表法分成观察组和对照组,每组60例。对照组患者采用床边纤维内镜吞咽功能检查(FEES),根据结果制定个体化吞咽康复训练方案,观察组患者在对照组的基础上增加肺功能康复,两组均连续治疗4周。两组患者均于治疗前和治疗后采用FEES评估其咽部残留与误吸情况。结果治疗后,两组患者的Roseabek渗漏-误吸程度分级均较治疗前明显改善(P<0.05),且观察组改善水平优于对照组(P<0.05)。治疗后,两组患者梨状窦及会厌谷残留Yale分级均较治疗前明显改善(P<0.05),且观察组改善水平优于对照组(P<0.05)。结论在个体化吞咽康复训练的基础上增加肺功能训练,有助于提高脑卒中气管切开伴吞咽障碍患者的吞咽功能,减少咽部残留及误吸,为气管套管拔除提供条件。Objective To observe the effect of early pulmonary function rehabilitation combined with individual swallowing training on pharyngeal residual and aspiration in stroke patients with tracheotomy and dysphagia.Methods 120 stroke patients with dysphagia after tracheotomy were randomly divided into observation group and control group with 60 patients in each group.The patients in the control group were evaluated by bedside electronic fiberoptic endoscopic evaluation of swallowing(FEES),and the individualized swallowing rehabilitation training program was formulated according to the results.The patients in the observation group increased pulmonary function rehabilitation on the basis of the control group.Both groups were treated continuously for 4 weeks.FEES was used to evaluate pharyngeal residual and aspiration in both groups before and after treatment.Results After treatment,the leakage-aspiration degree of Roseabek in both groups was significantly improved compared with that before treatment(P<0.05),the improvement level of the observation group was better than that of the control group(P<0.05).After treatment,the Yale grades of piriform sinus and epiglottic valley were significantly improved in both groups(P<0.05),the improvement level of the observation group was better than that of the control group(P<0.05).Conclusion Early pulmonary function rehabilitation combined with individual swallowing rehabilitation training can effectively improve the swallowing function of stroke patients with dysphagia after tracheotomy,reduce aspiration and pharyngeal residue,and provide conditions for extubation of trachea cannula.

关 键 词：气管切开 吞咽障碍 肺功能训练 吞咽训练 

分 类 号：R47[医药卫生—护理学]