舌压抗阻反馈训练结合中药冰棒咽部刺激治疗脑梗死后吞咽障碍的临床研究

发布时间：2018-08-30 07:41

【摘要】：脑血管疾病(Cerebrovascular Disease,CVD)是因颅内血液循环障碍而造成脑组织损害的一组疾病,其中脑梗死最常见,脑梗死具有高发病率、高致残率的特点。我国每年因心脑血管疾病而死亡的人数大约为260万,约占总死亡比例的45%[1]。吞咽功能障碍(deglutition disorders orswallowing disorder,DD or SD)是脑梗死患者常见的并发症之一,可并伴有发音含糊不清、费力,可引起误吸导致肺感染、营养不良、水电解质平衡失调等并发症,严重地影响脑梗死患者的预后。脑梗死康复是降低致残率最有效的方法。目前脑梗死后吞咽障碍患者进行吞咽康复训练已经广泛运用于临床,并取得较好的临床疗效。可见吞咽障碍的康复治疗在脑卒中的康复中至关重要,对缩短病程、减轻患者及家庭社会的负担、提高患者的生存质量、降低死亡率等方面都有显著的影响。舌压抗阻反馈训练是利用舌肌康复器进行吞咽训练一种吞咽康复方法,其灵感来源于舌骨上抬、前移运动的生理过程,训练的目标是通过舌压测定器的压力数据变化,视觉反馈让患者更容易体会吞咽动作的要领。强化舌肌上抬肌力,增加吞咽时舌骨上抬前移的幅度;增加舌头的感觉刺激,增强舌头控制、协调能力;增强舌头运送食物的能力。适用于脑卒中后舌部肌肉力量及协调不足。而中医作为祖国医学的瑰宝,中药冰棒咽部刺激在吞咽障碍的康复治疗中也显示出独特的疗效。本研究通过临床治疗与观测,联合治疗组与单一治疗组、对照组比较疗效均有显著差异,联合治疗组优于单一治疗组和对照组。希望本课题能为临床治疗提供一个全新的吞咽康复概念,促进吞咽障碍康复治疗的发展,为更多吞咽障碍的患者谋福利。目的:探讨舌压抗阻反馈训练结合中药冰棒咽部刺激治疗脑梗死后吞咽障碍的疗效。方法:选取脑梗死后吞咽障碍的患者120例,随机分为3组,每组40例。一般治疗组为对照组,给予常规的吞咽康复训练治疗;治疗A组除常规的吞咽康复训练治疗外还给予中药冰棒咽部刺激治疗;治疗B组为联合治疗组,在治疗A组基础上给予舌压抗阻反馈训练治疗,比较3组临床疗效。结果:三个治疗组均能改善吞咽障碍,但联合治疗组的疗效更优于其他组(P0.05)。结论:舌压抗阻反馈训练结合中药冰棒咽部刺激治疗脑梗死后吞咽障碍有显著疗效,可缩短治疗时间,有效改善吞咽功能,联合治疗较单一的康复治疗的疗效更佳。
[Abstract]:Cerebrovascular disease (Cerebrovascular Disease,CVD) is a group of diseases caused by intracranial blood circulation disturbance. Cerebral infarction is the most common one. Cerebral infarction has the characteristics of high incidence and high disability rate. The number of deaths due to cardiovascular and cerebrovascular diseases in China is about 2.6 million, accounting for 45% of the total deaths. Dysphagia (deglutition disorders orswallowing disorder,DD or SD) is one of the common complications in patients with cerebral infarction. It can be accompanied by ambiguous and laborious pronunciation, which can lead to pulmonary infection, malnutrition, water and electrolyte imbalance, etc. The prognosis of patients with cerebral infarction is seriously affected. Rehabilitation of cerebral infarction is the most effective method to reduce disability rate. At present, rehabilitation training has been widely used in patients with dysphagia after cerebral infarction. It can be seen that the rehabilitation treatment of dysphagia is very important in the rehabilitation of stroke, which has a significant effect on shortening the course of disease, lightening the burden of patients and families and society, improving the quality of life of patients, and reducing the mortality rate. Tongue pressure resistance feedback training is a kind of swallowing rehabilitation method using tongue muscle rehabilitation device. Its inspiration comes from the physiological process of hyoid upward and forward movement. The aim of the training is to change the pressure data of tongue pressure tester. Visual feedback makes it easier for patients to experience the essentials of swallowing. Strengthen tongue muscle lift strength, increase the amplitude of hyoid bone lifting forward during swallowing; increase tongue sensory stimulation, enhance tongue control and coordination ability; enhance tongue food delivery ability. It is suitable for the lack of muscle strength and coordination in the tongue after stroke. Chinese medicine as the treasure of traditional Chinese medicine, the traditional Chinese medicine ice popsicle pharynx stimulation in the rehabilitation treatment of dysphagia also showed a unique effect. Through clinical treatment and observation, the combined treatment group and the single treatment group, the control group have significant differences, the combined treatment group is better than the single treatment group and the control group. It is hoped that this study can provide a new concept of swallowing rehabilitation for clinical treatment, promote the development of rehabilitation therapy for dysphagia, and benefit more patients with dysphagia. Objective: to investigate the therapeutic effect of tongue pressure resistance feedback training combined with Chinese traditional Chinese medicine ice popsicle pharynx stimulation on dysphagia after cerebral infarction. Methods: 120 patients with dysphagia after cerebral infarction were randomly divided into 3 groups, 40 cases in each group. The general treatment group was the control group, which was given routine swallowing rehabilitation training treatment; the treatment group A was treated with traditional Chinese medicine ice-stick pharynx stimulation in addition to the routine swallowing rehabilitation training treatment; and the treatment group B was treated with combined treatment group. Group A was treated with tongue pressure resistance feedback training, and the clinical effects of three groups were compared. Results: all the three treatment groups could improve the dysphagia, but the curative effect of the combined treatment group was better than that of the other groups (P0.05). Conclusion: the treatment of dysphagia after cerebral infarction by tongue pressure resistance feedback training combined with traditional Chinese medicine ice popsicle pharynx stimulation can shorten the treatment time and improve the swallowing function effectively. The combined therapy is better than the single rehabilitation therapy.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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