CAJ | 학술논문

目的：探讨综合康复对脑卒中吞咽障碍并发认知和心理障碍患者的效果。方法120例脑卒中吞咽功能障碍并发认知和心理障碍患者分为实验组(n=60)和对照组(n=60)。两组入院后均进行神经内科常规治疗以及吞咽功能康复训练、摄食训练和低频电刺激等治疗；实验组在此基础上再进行认知功能和心理治疗。治疗前和治疗1个月后分别应用洼田饮水试验、简易精神状态检查(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评定。结果治疗1个月后，两组吞咽功能均显著改善(P<0.001)，且实验组显著优于对照组(P<0.001)。实验组总有效率90%，对照组总有效率73.3%，实验组明显优于对照组(P<0.01)。实验组MMSE评分显著提高(P<0.001)，且显著高于对照组(P<0.001)。而对照组评分改变无统计学意义(P>0.05)。实验组HAMD评分和HAMA评分显著降低(P<0.001)，且显著低于对照组(P<0.001)，而对照组仅HAMA评分降低(P<0.05)。结论在吞咽功能康复训练的同时对脑卒中吞咽障碍并发认知和心理障碍患者给予认知和心理治疗，不仅能改善认知功能和心理状态，还有利于吞咽功能的恢复。
목적：탐토종합강복대뇌졸중탄인장애병발인지화심리장애환자적효과。방법120례뇌졸중탄인공능장애병발인지화심리장애환자분위실험조(n=60)화대조조(n=60)。량조입원후균진행신경내과상규치료이급탄인공능강복훈련、섭식훈련화저빈전자격등치료；실험조재차기출상재진행인지공능화심리치료。치료전화치료1개월후분별응용와전음수시험、간역정신상태검사(MMSE)、한밀이돈억욱량표(HAMD)、한밀이돈초필량표(HAMA)진행평정。결과치료1개월후，량조탄인공능균현저개선(P<0.001)，차실험조현저우우대조조(P<0.001)。실험조총유효솔90%，대조조총유효솔73.3%，실험조명현우우대조조(P<0.01)。실험조MMSE평분현저제고(P<0.001)，차현저고우대조조(P<0.001)。이대조조평분개변무통계학의의(P>0.05)。실험조HAMD평분화HAMA평분현저강저(P<0.001)，차현저저우대조조(P<0.001)，이대조조부HAMA평분강저(P<0.05)。결론재탄인공능강복훈련적동시대뇌졸중탄인장애병발인지화심리장애환자급여인지화심리치료，불부능개선인지공능화심리상태，환유리우탄인공능적회복。
Objective To explore the clinical effect of psychological rehabilitation on dysphagia with cognitive and psychological disor-ders post stroke. Methods 120 stroke patients with dysphagia complicated with cognitive and psychological disorders were divided into ex-perimental group (n=60) and control group (n=60). Both groups received neurological routine medical treatment, swallowing function reha-bilitation training, feeding training and low-frequency electrical stimulation. Cognitive and psychological therapy was additionally used in the experimental group. Both groups were assessed by Kubota Drinking Water Test, Mini-Mental State Examination (MMSE), Hamilton Rat-ing Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA). Results 1 month after intervention, the score of Kubota Drinking Water Test improved significantly in both groups, and was higher in the experimental group than in the control group (P<0.001). The rate of clinical improvement was higher in the experimental group than in the control group (P<0.01). The scores of MMSE increased significantly in the experimental group (P<0.001). The scores of HAMD and HAMA decreased significantly in the experimental group (P<0.01). Only the scores of HAMA decreased in the control group (P<0.05). Conclusion Swallowing function rehabilitation training combined with cognitive and psychological therapy may facilitate to improve the cognitive function and psychological state and swallowing function for dysphagia with cognitive and psychological disorders post stroke.