情景模拟摄食训练联合重复经颅磁刺激治疗脑卒中吞咽障碍患者的临床疗效  

Scenario simulation feeding training combined with repetitive transcranial magnetic stimulation in the treatment of stroke patients with dysphagia

作　　者：张新杰 辛辉 李鹏 ZHANG Xin-jie;XIN Hui;LI Peng(Department of Rehabilitation,Xingtai Central Hospital,Xingtai Hebei 054000,China)

机构地区：[1]邢台市中心医院康复科,河北邢台054000

出　　处：《临床和实验医学杂志》2025年第3期269-273,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生计生委科技项目(编号:1120140236);邢台市科技计划项目(编号:2023ZC076);邢台市科技计划项目(编号:2019ZC187)。

摘　　要：目的探讨情景模拟摄食训练联合重复经颅磁刺激治疗脑卒中吞咽障碍患者的临床疗效。方法前瞻性选取邢台市中心医院2022年1月至2024年1月收治的120例脑卒中吞咽障碍患者,依据随机数字表法将其分为观察组与对照组,每组各60例。对照组患者实施常规吞咽刺激治疗,观察组在对照组基础上增加情景模拟摄食训练联合重复经颅磁刺激,两组均治疗4周。比较两组治疗4周后的临床疗效,治疗前、治疗4周后的血清营养指标(血红蛋白、白蛋白、前白蛋白、总蛋白),舌骨喉复合体移动距离变化(甲状软骨前移、甲状软骨上移、舌前移、舌骨上移),4周内并发症发生率,并比较两组治疗4周后的生活质量[生活质量综合评定量表(GQOLI-74)]。结果观察组的总有效率为96.67%,高于对照组(76.67%),差异有统计学意义(P<0.05)。治疗4周后,两组患者血清营养指标水平均较治疗前升高,且观察组的血红蛋白、白蛋白、前白蛋白、总蛋白分别为(113.59±3.24)、(55.71±3.68)、(0.28±0.05)、(71.79±4.47)g/L,均高于对照组[(110.12±3.64)、(51.06±2.44)、(0.24±0.04)、(63.47±6.38)g/L],差异均有统计学意义(P<0.05)。治疗4周后,两组甲状软骨前移、甲状软骨上移、舌前移及舌骨上移距离均较治疗前增高,且观察组患者治疗后甲状软骨前移、甲状软骨上移、舌前移及舌骨上移距离分别为(7.67±1.45)、(22.02±2.43)、(8.36±1.17)、(18.87±2.68)mm,均高于对照组[(6.27±1.69)、(19.54±3.54)、(6.37±1.38)、(14.06±2.44)mm],差异均有统计学意义(P<0.05)。观察组并发症总发生率为5.00%,低于对照组(16.67%),差异有统计学意义(P<0.05)。治疗4周后,两组GQOLI-74物质生活、心理功能、社会功能、躯体功能评分均较治疗前升高,且观察组患者GQOLI-74物质生活得分、心理功能、社会功能、躯体功能分别为(16.62±2.24)、(18.26±4.42)、(21.62±3.66)、(23.26±4.37)分,均高于对照组[(1Objective To investigate the clinical efficacy of scenario simulation feeding training combined with repetitive transcranial magnetic stimulation in the treatment of stroke patients with dysphagia.Methods A total of 120 patients with stroke dysphagia admitted to Xingtai Central Hospital from January 2022 to January 2024 were prospectively selected,and they were divided into the observation group and the control group according to the random number table method,with 60 cases in each group.The patients in the control group were treated with conventional swallowing stimulation,and the observation group was treated with scenario simulation feeding training combined with repeated transcranial magnetic stimulation on the basis of the control group,and both groups were treated for 4 weeks.The clinical efficacy after 4 weeks of treatment,serum nutritional indexes(hemoglobin,albumin,prealbumin,total protein),changes in the movement distance of the hyoid bone and laryngeal complex(thyroid cartilage advancement,thyroid cartilage advancement,tongue advancement,hyoid bone advancement)before treatment and after 4 weeks of treatment,and complication rates within 4 weeks were compared between the two groups.And finally the quality of life[generic quality of life inventory 74(GQOLI-74)]of the two groups before treatment and after 4 weeks of treatment were compared.Results The total effective rate of the observation group was 96.67%,which was higher than that of the control group(76.67%),the difference was statistically significant(P<0.05).After 4 weeks of treatment,the levels of serum nutritional indexes in the two groups were higher than those before treatment,and the levels of hemoglobin,albumin,prealbumin and total protein in the observation group were(113.59±3.24),(55.71±3.68),(0.28±0.05)and(71.79±4.47)g/L,respectively,which were higher than those in the control group[(110.12±3.64),(51.06±2.44),(0.24±0.04),(63.47±6.38)g/L],the differences were statistically significant(P<0.05).After 4 weeks of treatment,the distance o

关 键 词：脑卒中 吞咽障碍 情景模拟摄食训练 重复经颅磁刺激 营养状况 生活质量 

分 类 号：R743.3[医药卫生—神经病学与精神病学]