咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者对舌骨喉复合体动度的影响

doi:10.3760/cma.j.issn.1007-1245.2023.02.013

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (2): 200-.DOI: 10.3760/cma.j.issn.1007-1245.2023.02.013

咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者对舌骨喉复合体动度的影响

刘梅¹ 张娜² 贾茹¹ 高琳琳² 葛方方¹

¹济南市第二人民医院体检中心，济南　250000；²济南市第二人民医院内分泌科，济南　250000

出版日期:2023-01-15 发布日期:2023-01-30
通讯作者: 张娜，Email：2446672990@qq.com
基金资助:
山东省自然科学基金面上项目（ZR202103030420）

Effect of pharyngeal ice stimulation combined with feeding training on movement of hyoid laryngeal complex in patients with dysphagia after stroke

Liu Mei¹, Zhang Na², Jia Ru¹, Gao Linlin², Ge Fangfang¹

¹Physical Examination Center, Jinan Second People's Hospital, Jinan 250000, China; ²Department of Endocrinology, Jinan Second People's Hospital, Jinan 250000, China

Online:2023-01-15 Published:2023-01-30
Contact: Zhang Na, Email: 2446672990@qq.com
Supported by:
Project of Natural Science Fund in Shandong (ZR202103030420)

摘要/Abstract

摘要：

目的　探究咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者对舌骨喉复合体动度的影响。方法　选取济南市第二人民医院2018年1月至2021年12月收治的102例脑卒中后吞咽障碍患者，以电脑随机数字表法将其分为治疗组和对照组，各51例。对照组女30例，男21例，年龄（63.52±9.63）岁；治疗组女31例，男20例，年龄（62.36±9.12）岁。对照组予以摄食训练，治疗组予以咽部冰刺激联合摄食训练。比较两组患者训练前及治疗4周后视频透视吞咽检查（VFSS）评分、舌骨喉复合体动度及不良事件。采用t检验、χ²检验、Fisher确切概率法进行组间统计学比较。结果　训练前后治疗组的VFSS评分分别为（2.69±0.34）、（7.96±1.25）分，对照组分别为（2.85±0.41）、（5.62±1.02）分，训练前两组患者VFSS评分比较差异无统计学意义（P>0.05），训练后两组患者的VFSS评分均高于训练前，且训练后治疗组VFSS评分高于对照组（t=10.358，P<0.001）。两组患者训练前舌骨前移、舌骨上移比较，差异均无统计学意义（均P>0.05）；训练后，两组患者的舌骨前移、舌骨上移距离均高于训练前；且训练后治疗组舌骨前移、舌骨上移距离长于对照组（t=5.296、9.107，均P<0.001）。治疗组不良事件发生率为1.96%（1/51），对照组不良事件发生率为13.73%（7/51），治疗组不良事件发生率低于对照组（P=0.027）。结论　咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者，有助于提高患者吞咽功能，改善舌骨喉复合体动度，降低不良事件发生率。

关键词:

脑卒中, 吞咽障碍, 咽部冰刺激, 摄食训练, 不良事件发生率

Abstract:

Objective　To explore the effect of pharyngeal ice stimulation combined with feeding training on the movement of hyoid laryngeal complex in patients with dysphagia after stroke. Methods　A total of 102 patients with dysphagia after stroke admitted to Jinan Second People's Hospital from January 2018 to December 2021 were selected and divided into a treatment group and a control group by the computer random number method, with 51 cases in each group. In the control group, there were 30 females and 21 males who were (63.52±9.63) years old. There were 31 females and 20 males in the treatment group who were (62.36±9.12) years old. The control group took feeding training; the treatment group took pharyngeal ice stimulation and feeding training. The scores of Video Fluoroscopic Swallowing Study (VFSS) and hyoid laryngeal complex movement before and 4 weeks after the treatment and adverse events were compared between the two groups. t test, χ² test, and Fisher's exact test were applied. Results　There was no statistical difference in the VFSS score between the treatment group and the control group before the training [(2.69±0.34) vs. (2.85±0.41); P>0.05]. After the training, there was a statistical difference in the VFSS score between the treatment group and the control group [(7.96±1.25) vs. (5.62±1.02); t=10.358, P<0.001]. Before the training, there were no statistical differences in hyoid bone movement and hyoid bone movement between the two groups (both P>0.05). After the training, the anterior and upper hyoid displacement distances of the two groups were higher than those before the training. After the training, the anterior and upper hyoid displacement distances of the treatment group were longer than those of the control group (t=5.296 and 9.107; both P<0.001). The incidence of adverse events in the treatment group was lower than that in the control group [1.96% (1/51) vs. 13.73% (7/51); P=0.027]. Conclusion　Pharyngeal ice stimulation combined with feeding training for patients with dysphagia after stroke is helpful to improve their swallowing function and movement of hyoid laryngeal complex and to reduce the incidence of adverse events.

Key words:

, Stroke, Dysphagia, Pharyngeal ice stimulation, Feeding training, Incidence of adverse events

刘梅张娜贾茹高琳琳葛方方 .

咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者对舌骨喉复合体动度的影响 [J]. 国际医药卫生导报, 2023, 29(2): 200-.

Liu Mei, Zhang Na, Jia Ru, Gao Linlin, Ge Fangfang.

Effect of pharyngeal ice stimulation combined with feeding training on movement of hyoid laryngeal complex in patients with dysphagia after stroke [J]. International Medicine and Health Guidance News, 2023, 29(2): 200-.

参考文献

[1] Jan S, Arsh A, Darain H, et al. A randomized control trial comparing the effects of motor relearning programme and mirror therapy for improving upper limb motor functions in stroke patients[J]. J Pak Med Assoc, 2019,69(9):1242-1245.
[2] Zhang J, Wu Y, Huang Y, et al. Effect of the mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia[J]. J Int Med Res, 2021,49(5):3000605211013198. DOI: 10.1177/03000605211013198.
[3] Rech KD, Salazar AP, Marchese RR, et al. Fugl-meyer assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020,29(1):104463. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104463.
[4] Fong KNK, Ting KH, Chan CCH, et al. Mirror therapy with bilateral arm training for hemiplegic upper extremity motor functions in patients with chronic stroke[J]. Hong Kong Med J, 2019,25 Suppl 3(1):30-34. DOI:10.12809/HKMJ177150.
[5] Turan Z, Zinnuroğlu M. Peripheral axonal excitability in hemiplegia related to subacute stroke[J]. Turk J Med Sci, 2020,50(8):1983-1992. DOI: 10.3906/sag-2004-306.
[6] Obradovic D, Andjelic T, Ninkovic M, et al. Superoxide dismutase (SOD), advanced oxidation protein products (AOPP), and disease-modifying treatment are related to better relapse recovery after corticosteroid treatment in multiple sclerosis[J]. Neurol Sci, 2021,42(8):3241-3247. DOI: 10.1007/s10072-020-04928-y.
[7] Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores[J]. Int J Geriatr Psychiatry, 2018,33(2):379-388. DOI: 10.1002/gps.4756.
[8] Olivato S, Nizzoli S, Cavazzuti M, et al. e-NIHSS: an expanded National Institutes of Health Stroke Scale weighted for anterior and posterior circulation strokes[J]. J Stroke Cerebrovasc Dis, 2016,25(12):2953-2957. DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.011.
[9] Abu Assab T, Raveh-Brawer D, Abramowitz J, et al. The predictive value of thromboelastogram in the evaluation of patients with suspected acute venous thromboembolism[J]. Acta Haematol, 2020,143(3):272-278. DOI: 10.1159/000502348.
[10] 中华中医药学会脑病分会,广东省中医药学会脑病专业委员会,广东省中西医结合学会卒中专业委员会.中西医结合脑卒中循证实践指南(2019)[J].中国循证医学杂志,2020,20(8):901-912.DOI:10.7507/1672-2531.202001075.
[11] Stevens M, Mayerl CJ, Bond L, et al. Pathophysiology of aspiration in a unilateral SLN lesion model using quantitative analysis of VFSS[J]. Int J Pediatr Otorhinolaryngol, 2021,140:110518. DOI: 10.1016/j.ijporl.2020.110518.
[12] Luu D, Komisarow J, Mills BM, et al. Eustyngeal disorder in stroke[J]. Neurocrit Care, 2021,35(2):434-440.
[13] Bogdanov S, Brookes N, Epps A, et al. Fatigue in children with moderate or severe traumatic brain injury compared with children with orthopedic injury: characteristics and associated factors[J]. J Head Trauma Rehabil, 2021,36(2):E108-E117. DOI: 10.1097/HTR.0000000000000585.
[14] Obradovic D, Andjelic T, Ninkovic M, et al. Superoxide dismutase (SOD), advanced oxidation protein products (AOPP), and disease-modifying treatment are related to better relapse recovery after corticosteroid treatment in multiple sclerosis[J]. Neurol Sci, 2021,42(8):3241-3247. DOI: 10.1007/s10072-020-04928-y.
[15] Gasparyan AY, Ayvazyan L, Mukanova U, et al. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases[J]. Ann Lab Med, 2019,39(4):345-357. DOI: 10.3343/alm.2019.39.4.345.
[16] Liu Y, Dong YH, Lyu PY, et al. Hypertension-induced cerebral small vessel disease leading to cognitive impairment[J]. Chin Med J (Engl), 2018,131(5):615-619. DOI: 10.4103/0366-6999.226069.
[17] Pressly MA, Parker RS, Neal MD, et al. Accelerating availability of clinically-relevant parameter estimates from thromboelastogram point-of-care device[J]. J Trauma Acute Care Surg, 2020,88(5):654-660. DOI: 10.1097/TA.0000000000002608.
[18] Piche SL, Nei SD, Frazee E, et al. Baseline Thromboelastogram as a predictor of left ventricular assist device thrombosis[J]. ASAIO J, 2019,65(5):443-448. DOI: 10.1097/MAT.0000000000000828.
[19] Ebata N, Tomita Y, Mills I. Mendelssohn and the schãœbler chorales (bwv 645-650): a new source found in the riemenschneider bach institute collection[J]. Bach, 2013, 44(1):1-45.
[20] Ranzani R, Lambercy O, Metzger JC, et al. Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke[J]. J Neuroeng Rehabil, 2020,17(1):115. DOI: 10.1186/s12984-020-00746-7.
[21] Xu Q, Li C, Pan Y, et al. Impact of smart force feedback rehabilitation robot training on upper limb motor function in the subacute stage of stroke[J]. NeuroRehabilitation, 2020,47(2):209-215. DOI: 10.3233/NRE-203130.
[22] 危昔均,韦亦茜,秦萍,等.基于沉浸式虚拟现实脑卒中偏瘫上肢功能康复系统构建及临床可行性研究[J].中西医结合心脑血管病杂志,2021,19(11):1949-1952.DOI:10.12102/j.issn.1672-1349.2021.11.042.
[23] Lee SH, Kim WS, Park J, et al. Effects of anodal transcranial direct current stimulation over the contralesional hemisphere on motor recovery in subacute stroke patients with severe upper extremity hemiparesis: study protocol for a randomized controlled trial[J]. Medicine (Baltimore), 2020,99(14):e19495. DOI: 10.1097/MD.0000000000019495.
[24] Hsieh YW, Lin YH, Zhu JD, et al. Treatment effects of upper limb action observation therapy and mirror therapy on rehabilitation outcomes after subacute stroke: a pilot study[J]. Behav Neurol, 2020,2020:6250524. DOI: 10.1155/2020/6250524.
[25] Wu D, Ma J, Zhang L, et al. Effect and safety of transcutaneous auricular vagus nerve stimulation on recovery of upper limb motor function in subacute ischemic stroke patients: a randomized pilot study[J]. Neural Plast, 2020,2020:8841752. DOI: 10.1155/2020/8841752.
[26] Chen ZJ, He C, Xia N, et al. Association between finger-to-nose kinematics and upper extremity motor function in subacute stroke: a principal component analysis[J]. Front Bioeng Biotechnol, 2021,9:660015. DOI: 10.3389/fbioe.2021.660015.
[27] 刘莉莉,王玲,于峰.脑电仿生电刺激联合上肢智能力反馈康复机器人治疗老年急性缺血性脑卒中的临床研究[J].中西医结合心脑血管病杂志,2021,19(23):4148-4151.DOI:10.12102/j.issn.1672-1349.2021.23.033.
[28] Chien WT, Chong YY, Tse MK, et al. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: a systematic review and meta-analysis[J]. Brain Behav, 2020,10(8):e01742. DOI: 10.1002/brb3.1742.
[29] Lee HC, Kuo FL, Lin YN, et al. Effects of robot-assisted rehabilitation on hand function of people with stroke: a randomized, crossover-controlled, assessor-blinded study[J]. Am J Occup Ther, 2021,75(1):7501205020p1-7501205020p11. DOI: 10.5014/ajot.2021.038232.

咽部冰刺激联合摄食训练应用于脑卒中后吞咽障碍患者对舌骨喉复合体动度的影响

Effect of pharyngeal ice stimulation combined with feeding training on movement of hyoid laryngeal complex in patients with dysphagia after stroke

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

编辑推荐

Metrics