| 摘要: |
| ［摘要］ 目的 观察自由饮水训练联合低频脉冲电刺激治疗脑卒中后吞咽障碍的效果。方法 招募2022年3月至2024年3月武汉市中心医院收治的脑卒中后吞咽障碍患者112例，采用随机数字表法将其分为观察组和对照组，各56例。除冰水刺激软腭和舌根、口周肌肉训练、呼吸功能训练及发音训练等常规康复训练外，对照组采用低频脉冲电刺激治疗，观察组在对照组基础上联合自由饮水训练，疗程均为2个月。比较两组洼田饮水试验结果、吞咽障碍指数（DHI）评分、吞咽障碍生命质量量表（EDQoL）评分、Barthel指数评分、进食评估问卷调查工具-10（EAT-10）评分。采用电视荧光吞咽造影检查（VFSS）测量舌骨前移距离、舌骨上移距离、甲状软骨前移距离和甲状软骨上移距离。采用酶联免疫吸附法测定血清脑源性神经营养因子（BDNF）、P物质（SP）、神经元特异性烯醇化酶（NSE）、神经生长因子（NGF）和S100β蛋白水平。结果 观察组康复治疗有效率显著高于对照组（85.71% vs 69.64%； χ2=4.171，P=0.041）。在治疗后，观察组DHI的情感、生理、功能维度评分以及EDQoL、EAT-10评分显著低于对照组（P<0.05），Barthel指数评分显著高于对照组（P<0.05）。观察组治疗后的甲状软骨前移距离、甲状软骨上移距离、舌骨前移距离和舌骨上移距离显著大于对照组（P<0.05）。观察组治疗后血清BDNF、SP及NGF水平高于对照组，S100β蛋白、NSE水平低于对照组，差异有统计学意义（P<0.05）。结论 自由饮水训练联合低频脉冲电刺激可有效改善脑卒中后吞咽障碍，促进神经功能恢复，提高患者生活质量。 |
| 关键词: 自由饮水训练 低频脉冲电刺激 脑卒中后吞咽障碍 康复治疗 |
| DOI：10.3969/j.issn.1674-3806.2025.08.13 |
| 分类号:R 493 |
| 基金项目:武汉市医学科学研究项目（编号：WX23B49） |
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| Observation on the effect of free-drinking water training combined with low-frequency pulse electrical stimulation in treatment of post-stroke dysphagia |
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ZHONG Xiuwen, YOU Fei, MA Zhaoyang, XIAO Pei, ZHENG Jinkun, LIU Lian, CHEN Qiao
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Department of Rehabilitation Medicine, the Central Hospital of Wuhan, Wuhan 430000, China
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| Abstract: |
| ［Abstract］ Objective To observe the effect of free-drinking water training combined with low-frequency pulse electrical stimulation in treatment of post-stroke dysphagia(PSD). Methods One hundred and twelve patients with PSD who were admitted to the Central Hospital of Wuhan from March 2022 to March 2024 were recruited and divided into observation group and control group by random number table method, with 56 patients in each group. In addition to the conventional rehabilitation training methods such as ice water stimulating the soft palate and tongue root, perioral muscle training, respiratory function training and pronunciation training, the control group was treated with low-frequency pulse electrical stimulation, while the observation group was treated with free-drinking water training on the basis of the same treatment as the control group. The treatment course was 2 months in both groups. The results of water swallow test(WST), Dysphagia Handicap Index(DHI) scores, Eating Disorder Quality of Life Scale(EDQoL) scores, Barthel Index scores and Eating Assessment Tool-10(EAT-10) scores were compared between the two groups. The anterior displacement distance of the hyoid bone, the upward displacement distance of the hyoid bone, the anterior displacement distance of the thyroid cartilage and the upward displacement distance of the thyroid cartilage were measured by using video-fluoroscopic swallowing study(VFSS). The levels of serum brain-derived neurotrophic factor(BDNF), substance P(SP), neuron-specific enolase(NSE), nerve growth factor(NGF) and S100β protein were determined by using enzyme-linked immunosorbent assay(ELISA). Results The effective rate of rehabilitation therapy in the observation group was significantly higher than that in the control group(85.71% vs 69.64%; χ2=4.171, P=0.041). After the rehabilitation therapy, the scores of the emotional, physiological and functional dimensions of DHI, as well as the EDQoL scores and EAT-10 scores in the observation group were significantly lower than those in the control group(P<0.05), and the Barthel index scores in the observation group were significantly higher than those in the control group(P<0.05). After the rehabilitation therapy, the anterior displacement distance of the thyroid cartilage, the upward displacement distance of the thyroid cartilage, the anterior displacement distance of the hyoid bone, the upward displacement distance of the hyoid bone in the observation group were significantly greater than those in the control group(P<0.05). After the rehabilitation therapy, the levels of serum BDNF, SP and NGF in the observation group were higher than those in the control group, while the levels of S100β protein and NSE in the observation group were lower than those in the control group, with statistically significant differences between the two groups(P<0.05). Conclusion Free-drinking water training combined with low-frequency pulse electrical stimulation can effectively improve the patients′ PSD, promote the recovery of neurological function, and improve their living quality. |
| Key words: Free-drinking water training Low-frequency pulse electrical stimulation Post-stroke dysphagia(PSD) Rehabilitation therapy |
