CAJ | 학술논문

目的探讨不同训练方法对环咽肌失弛缓患者吞咽前食管上段括约肌(UES)压力及吞咽功能的影响.方法共选取57例脑卒中后环咽肌失弛缓患者,按随机数字表法将其分为常规训练组、球囊扩张组、综合训练组,每组19例.3组患者均给予吞咽电刺激治疗和吞咽功能训练,常规训练组和球囊扩张组在此基础上分别增加喉上提训练和球囊扩张术治疗,综合训练组在电刺激和吞咽功能训练基础上增加喉上提训练及球囊扩张术治疗.治疗前及治疗8周后(治疗后),利用高分辨多通道胃肠功能检测仪对患者吞咽前UES压力进行测定,采用洼田饮水试验和藤岛一郎吞咽障碍分级评定患者的吞咽功能.结果治疗前,3组患者吞咽前UES压力、吞咽障碍评级、洼田饮水试验分级及视频透视吞咽检查(VFSS)结果比较,差异均无统计学意义(P＞0.05).与组内治疗前比较,球囊扩张组治疗后吞咽前UES压力[(266.4±82.7) mmHg]和综合训练组治疗后吞咽前UES压力[(269.5±83.2)mmHg]均显著提高(P＜0.05),且综合训练组治疗后吞咽前UES压力高于球囊扩张组(P＜0.05).治疗后,球囊扩张组和综合训练组患者吞咽障碍分级、洼田饮水试验分级及VFSS结果均较治疗前有所好转(P＜0.05),且综合训练组患者上述指标较球囊扩张组改善更为显著(P＜0.05).结论在吞咽电刺激和功能训练基础上增加球囊扩张术和喉上提训练,可有效提高环咽肌失弛缓患者吞咽前的UES压力,降低UES张力,对其康复治疗具有重要意义.
목적 탐토불동훈련방법대배인기실이완환자탄인전식관상단괄약기(UES)압력급탄인공능적영향.방법 공선취57례뇌졸중후배인기실이완환자,안수궤수자표법장기분위상규훈련조、구낭확장조、종합훈련조,매조19례.3조환자균급여탄인전자격치료화탄인공능훈련,상규훈련조화구낭확장조재차기출상분별증가후상제훈련화구낭확장술치료,종합훈련조재전자격화탄인공능훈련기출상증가후상제훈련급구낭확장술치료.치료전급치료8주후(치료후),이용고분변다통도위장공능검측의대환자탄인전UES압력진행측정,채용와전음수시험화등도일랑탄인장애분급평정환자적탄인공능.결과 치료전,3조환자탄인전UES압력、탄인장애평급、와전음수시험분급급시빈투시탄인검사(VFSS)결과비교,차이균무통계학의의(P＞0.05).여조내치료전비교,구낭확장조치료후탄인전UES압력[(266.4±82.7) mmHg]화종합훈련조치료후탄인전UES압력[(269.5±83.2)mmHg]균현저제고(P＜0.05),차종합훈련조치료후탄인전UES압력고우구낭확장조(P＜0.05).치료후,구낭확장조화종합훈련조환자탄인장애분급、와전음수시험분급급VFSS결과균교치료전유소호전(P＜0.05),차종합훈련조환자상술지표교구낭확장조개선경위현저(P＜0.05).결론 재탄인전자격화공능훈련기출상증가구낭확장술화후상제훈련,가유효제고배인기실이완환자탄인전적UES압력,강저UES장력,대기강복치료구유중요의의.
Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter (UES) in patients with post-stroke cricopharyngeal achalasia,and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis.Methods Fifty-seven stroke patients with cricopharyngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallowing training group with 19 patients in eachp.All the three groups accepted routine swallowing training.In addtion,the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training,respectively,while the combined training group accepted larynx elevation training and balloon dilation training simultaneously.The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR,CTD-synectics,Sweden) before and after 8 weeks of treatment.The swallowing function was assessed using swallowing function classification and water swallowing test.Results Before treatment,there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS (P ＞ 0.05).After treatment,pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment (P ＜ 0.05),and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group(P ＜O.05).Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase pre-swallow peak UES pressure,decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia,which is of great importance for their recovery.