在X线下观察吞咽姿势对脑卒中后吞咽障碍的影响

发布时间：2018-04-19 10:14

本文选题：吞咽障碍 + 吞咽姿势　；参考：《郑州大学》2013年硕士论文

【摘要】：目的：吞咽障碍是脑卒中后的常见并发症之一,据报道,其发生率约占30%-65%,颅脑损伤造成吞咽障碍高达61%-93%。可造成食物残留、呛咳、误咽、气道梗阻、反复吸入性肺炎、营养不良和脱水等并发症,甚至窒息危及生命,严重影响患者的康复疗效和生活质量。本文通过电视透视吞咽造影,观察不同体位和头部姿势改变对脑卒中后吞咽障碍患者的影响,以及其对会厌谷和梨状窦残留物的清理作用。方法：选择2011年9月至2012年8月本院收治的69例经电视透视吞咽检查(VFSS)显示存在吞咽障碍和残留的脑卒中患者,在X线下观察患者分别在30°、60°、90°仰卧位时,不同的体位对患者口腔期和咽期吞咽的影响,以及仰头吞咽和头旋转吞咽对会厌谷和梨状窦残留物的清理作用。选择误吸最明显的体位嘱患者低头吞咽,观察低头吞咽是否可以减少或防止误吸。将69例患者随机分为观察组和治疗组,治疗组进行常规吞咽训练,观察组选择在30°仰卧位进行吞咽功能训练,在60°仰卧位进行仰头吞咽和头旋转吞咽清除会厌谷和梨状窦残留,在直接训练时采取低头吞咽,在治疗1个月后再次进行饮水实验和VFSS检查。结果：本研究结果显示,在30°、60°、90°仰卧位三种体位中,在90°仰卧位时会厌谷残留最明显,在30°、60°仰卧位时残留减少,梨状窦残留在三种体位无明显区别。在60°仰卧位时,头旋转吞咽和仰头吞咽清理残留物更加有效,而且清除梨状窦和会厌谷残留物容积也最多。60°仰卧位时碘剂通过口咽时间较短。30°仰卧位时防止误咽效果最好。90°仰卧位时误吸最明显,在此位置嘱患者低头吞咽可有效防止误吸。两组患者治疗前洼田氏饮水实验分级及VFSS检查结果比较,组间差异均无统计学意义(P0.05),经过一个月治疗后,两组患者吞咽功能均较治疗前明显提高,差异具有统计学意义(P0.05),而且观察组提高较治疗组明显,组问比较差异亦具有统计学意义(P0.05)。结论：吞咽姿势改变是让患者的头部或身体改变某种姿势即可解除吞咽障碍的症状,而且可改善或消除吞咽时的误吸症状。此方法能保持患者的正常生理功能,提高吞咽的安全性,根据电视透视吞咽造影(VFSS)检查结果选择在30°仰卧位进行吞咽功能训练,在60°仰卧位清除会厌谷和梨状窦残留,在直接训练时采取低头吞咽,临床研究显示,应用此方法,可明显提高患者吞咽功能,治疗效果优于常规吞咽训练,明显减少吸入性肺炎的发生,提高了患者生存率和生活质量。
[Abstract]:Objective: dysphagia is one of the common complications after stroke. It is reported that the incidence of dysphagia is about 30%-65, and the swallowing disorder caused by craniocerebral injury is as high as 61-933.It can cause food residue, cough, false pharynx, airway obstruction, repeated aspiration pneumonia, malnutrition, dehydration and other complications, even suffocation endangers life, seriously affecting the rehabilitation effect and quality of life of patients.The effects of different postural and head posture changes on patients with dysphagia after stroke and their cleaning effects on the residues of epiglottic valley and piriform sinus were observed by means of television fluoroscopy.Methods: from September 2011 to August 2012, 69 patients with stroke who had dysphagia and residual cerebral apoplexy were examined by VFSS. The patients were observed in the supine position of 30 掳(60 掳) and 90 掳(90 掳) under X-ray, respectively.The effects of different postures on oral and pharyngeal swallowing, as well as on the removal of residual residues of epiglottic valley and piriform sinus by scalp swallowing and head rotation swallowing.Choose the most obvious body position to ask the patient to swallow down and see if the swallowing can reduce or prevent accidental aspiration.69 patients were randomly divided into observation group and treatment group. Routine swallowing training was performed in the treatment group, swallowing function training was performed in 30 掳supine position, supine swallowing and head rotation swallowing were performed in 60 掳supine position to remove residual of epiglottic valley and piriform sinus.After one month of treatment, drinking water test and VFSS examination were performed again.Results: the results showed that in the supine position of 30 掳and 60 掳and 90 掳, the residual of the epiglottic valley was the most obvious in the supine position of 90 掳, decreased in the supine position of 30 掳and 60 掳, and remained in the Pyriform sinus in the three postures.At 60 掳supine position, head rotated swallowing and supine swallowing are more effective in cleaning up residue,Moreover, when removing the residue volume of piriform sinus and epiglottic valley at the maximum of .60 掳supine position, the effect of iodine on the oral pharynx time was shorter. 30 掳supine position was the most effective in preventing mispharyngeal aspiration. In this position, it was the best to prevent mispharyngeal aspiration in the supine position of .90 掳. In this position, ordering the patient to lower his head and swallow can effectively prevent misabsorption.After one month of treatment, the swallowing function of the two groups was significantly improved, compared with the results of Wada's drinking water test and VFSS examination, no significant difference was found between the two groups after one month of treatment, and there was no significant difference between the two groups after one month of treatment, the swallowing function of the two groups was significantly higher than that of the control group.The difference was statistically significant (P 0.05), and the improvement in the observation group was significantly higher than that in the treatment group, and the difference between the two groups was statistically significant (P 0.05).Conclusion: swallowing posture change can relieve the symptoms of dysphagia, and can improve or eliminate the symptoms of swallowing.This method can maintain the normal physiological function of the patients and improve the safety of swallowing. According to the results of TV fluoroscopic swallowing angiography (VFSS), the patients were given swallowing function training in 30 掳supine position and 60 掳supine position to clear the residual of epiglottic Valley and Pyriform sinus.The clinical research shows that this method can obviously improve the swallowing function of the patients, and the therapeutic effect is better than that of the routine swallowing training, and the incidence of aspiration pneumonia is obviously reduced.The survival rate and quality of life were improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R493;R816

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