导尿管球囊扩张术治疗脑卒中后神经源性环咽肌失弛缓症的疗效研究

发布时间：2018-03-14 21:17

本文选题：导尿管球囊扩张术　切入点：脑卒中　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察导尿管球囊扩张术对脑卒中后环咽肌失弛缓造成吞咽功能障碍的疗效。方法本研究选取2013年2月至2014年2月期间在郑州大学第一附属医院康复医学科住院的32例脑卒中后环咽肌失弛缓造成吞咽功能障碍的患者。采用随机数字表法,将符合标准的患者随机分为治疗组和对照组，各16例。两组患者均给予常规康复治疗，包括吞咽基础训练、摄食训练、Vitalstim电刺激治疗、针灸疗法、经颅磁刺激治疗。治疗组患者在给予常规康复治疗的基础上加用导尿管球囊扩张术治疗。常规康复治疗每日1次，每周治疗6d，导尿管球囊扩张术治疗每日2次，每次8-10遍，每次大约30min，每周治疗6d，每次增加0.5～1ml，注水量最大不超过15ml，两组的治疗终点是恢复经口进食或治疗达2周。评估两组患者治疗前与治疗后吞咽障碍程度评分、吞咽功能评分、VFSS咽通过时间和吞咽功能评价。结果两组患者治疗前吞咽障碍程度评分、吞咽功能评定和VFSS咽通过时间差异均无统计学意义（P0.05）。患者经口进食或治疗时间达2周后两组患者的吞咽障碍程度评分和吞咽功能评定均有改善（P＜0.05），且上述指标以治疗组的改善更加明显，，与对照组比较，差异均有统计学意义（P＜0.05），治疗前与治疗后的组内比较，差异均有统计学意义(P＜0.05)。恢复经口进食或治疗达2周后治疗组咽通过时间比对照组明显缩短（P＜0.05）。治疗组治疗后比治疗前咽通过时间明显缩短(P＜0.05)，治疗前后对照组组内比较，差异无统计学意义(P＞0.05)。两组患者经口进食或治疗2周后，治疗组16例患者当中有12例患者可以经口进食水、固体食物及流质食物，有14例患者恢复进食糊状食物。对照组16例患者，恢复进食水、固体食物及流质食物的有5例，进食糊状食物的有9例。两组患者吞咽功能比较，差异具有统计学意义（P＜0.05）。结论使用改进方案后的导尿管球囊扩张术治疗脑卒中后环咽肌失弛缓所导致的吞咽功能障碍与常规治疗方法相比，明显缩短了治疗时间，在短时间内提高患者的进食能力，是一种更加有效的治疗方法，值得在临床中推广。
[Abstract]:Purpose. To observe the effect of balloon dilatation of urethral catheter on dysphagia caused by achalasia of cricopharynx muscle after stroke. Method. From February 2013 to February 2014, 32 patients with dysphagia caused by achalasia after stroke were enrolled in the Department of Rehabilitation Medicine of the first affiliated Hospital of Zhengzhou University. The patients who met the standard were randomly divided into treatment group (n = 16) and control group (n = 16). The patients in both groups were given routine rehabilitation therapy, including basic swallowing training, feeding training and Vitalstim electric stimulation, acupuncture therapy. The patients in the treatment group were treated with catheter balloon dilatation on the basis of routine rehabilitation therapy. Routine rehabilitation therapy was performed once a day, 6 days a week, and 2 times a day, 8-10 times each time. Patients in each group were treated for about 30 minutes for 6 days per week, with an increase of 0.5ml per week, with a maximum injection of no more than 15ml. The end point of treatment in both groups was to resume oral feeding or treatment for up to 2 weeks. Evaluate the degree of dysphagia before and after treatment in both groups. The score of swallowing function was evaluated by VFSS through time and swallowing function. Results. The score of degree of dysphagia before treatment in the two groups, There was no significant difference in swallowing function and VFSS's pharyngeal transit time between the two groups (P < 0.05). After oral feeding or treatment for 2 weeks, the scores of deglutition disorder and the evaluation of swallowing function were improved in both groups (P < 0.05), and the above indexes were treated. The improvement in the treatment group was more obvious. Compared with the control group, the difference was statistically significant (P < 0.05). The difference was statistically significant (P < 0.05). The pharynx passage time of the treatment group was significantly shorter than that of the control group after the recovery of oral feeding or treatment for 2 weeks (P < 0.05). The pharyngeal passage time of the treatment group was significantly shorter than that of the pre-treatment group (P < 0.05), and that of the control group before and after treatment was significantly shorter than that of the control group (P < 0.05). There was no significant difference between the two groups (P > 0.05). After two weeks of oral feeding or treatment, 12 of the 16 patients in the treatment group could eat water, solid food and liquid food through mouth. In the control group, there were 16 patients, 5 patients returned to water, solid food and liquid food, and 9 patients ate paste food. There was a significant difference in swallowing function between the two groups (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). Conclusion. The treatment of dysphagia caused by retrograde catheter balloon dilatation after stroke was significantly shorter than that of conventional therapy, and the feeding ability of patients was improved in a short time. It is a more effective treatment method and is worth popularizing in clinic.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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