中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2013年
2期
126-129
,共4页
导尿管球囊扩张术%脑卒中%环咽肌失弛缓症%吞咽障碍%电视透视下吞咽能力检查%介入时机
導尿管毬囊擴張術%腦卒中%環嚥肌失弛緩癥%吞嚥障礙%電視透視下吞嚥能力檢查%介入時機
도뇨관구낭확장술%뇌졸중%배인기실이완증%탄인장애%전시투시하탄인능력검사%개입시궤
Catheter balloon dilatation therapy%Stroke%Cricopharyngeal achalasia%Dysphagia
目的 观察导尿管球囊扩张术介入时间不同对脑卒中后环咽肌失弛缓症疗效的影响.方法 选取经电视X线透视吞咽功能检查(VFSS)诊断为脑卒中后环咽肌失弛缓症的吞咽障碍患者48例,根据导尿管球囊扩张术介入时间的不同,将患者分为A、B、C和D4组,每组12例.4组均采用注水方式使球囊充盈以扩张环咽肌,同时辅以低频电刺激及吞咽康复行为治疗.分别于治疗前和治疗终点(恢复经口进食或治疗满6周后)采用吞咽功能临床评价和VFSS分别对4组患者所需球囊扩张次数、咽通过时间、吞咽障碍程度及疗效进行评定.结果 治疗终点时,4组患者所需球囊扩张次数分别为(8.12±4.35)次、(9.68 ±4.26)次、(13.59 ±5.47)次、(19.85 ±8.61)次,A组、B组及C组患者所需的球囊扩张次数明显少于D组(P＜0.05),A组、B组患者所需的球囊扩张次数亦少于C组(P＜0.05),但A组与B组间差异无统计学意义(P＞0.05).治疗终点时,A组和B组均有11例患者可进食水、流质物、糊状物及固体食物,而C组可进食上述4种性状食物的患者分别为9、9、10和9例,D组则分别为6、6、7、5例,A组、B组及C组的吞咽功能均优于D组(P＜0.05),A组、B组的吞咽功能亦显著优于C组(P＜0.05),但 A组与B组间差异无统计学意义(P＞0.05).A、B、C、D 4组患者治疗后的咽通过时间较治疗前均缩短[(0.14 ±0.07)s对(0.22 ±0.04)s、(0.14±0.08)s对(0.22 ±0.06)s、(0.16 ±0.05)s对(0.21 ±0.08)s、(0.19 ±0.09)s对(0.23±0.10)s,均P＜0.05],A组、B组及C组的咽通过时间显著短于D组(P＜0.05),A组、B组的咽通过时间亦短于C组,但A组与B组间差异无统计学意义(P＞0.05).治疗终点时,A、B、C、D4组VFSS有效率分别为91.66％、91.66％、83.33％、58.33％,A组、B组及C组的有效率显著优于D组(P＜0.05),A组、B组的有效率亦显著优于C组(P＜0.05),但A组与B组间差异无统计学意义(P＞0.05).结论 早期介入导尿管球囊扩张术可有效改善脑卒中后环咽肌失弛缓症患者的吞咽功能,提高其生活质量.
目的 觀察導尿管毬囊擴張術介入時間不同對腦卒中後環嚥肌失弛緩癥療效的影響.方法 選取經電視X線透視吞嚥功能檢查(VFSS)診斷為腦卒中後環嚥肌失弛緩癥的吞嚥障礙患者48例,根據導尿管毬囊擴張術介入時間的不同,將患者分為A、B、C和D4組,每組12例.4組均採用註水方式使毬囊充盈以擴張環嚥肌,同時輔以低頻電刺激及吞嚥康複行為治療.分彆于治療前和治療終點(恢複經口進食或治療滿6週後)採用吞嚥功能臨床評價和VFSS分彆對4組患者所需毬囊擴張次數、嚥通過時間、吞嚥障礙程度及療效進行評定.結果 治療終點時,4組患者所需毬囊擴張次數分彆為(8.12±4.35)次、(9.68 ±4.26)次、(13.59 ±5.47)次、(19.85 ±8.61)次,A組、B組及C組患者所需的毬囊擴張次數明顯少于D組(P＜0.05),A組、B組患者所需的毬囊擴張次數亦少于C組(P＜0.05),但A組與B組間差異無統計學意義(P＞0.05).治療終點時,A組和B組均有11例患者可進食水、流質物、糊狀物及固體食物,而C組可進食上述4種性狀食物的患者分彆為9、9、10和9例,D組則分彆為6、6、7、5例,A組、B組及C組的吞嚥功能均優于D組(P＜0.05),A組、B組的吞嚥功能亦顯著優于C組(P＜0.05),但 A組與B組間差異無統計學意義(P＞0.05).A、B、C、D 4組患者治療後的嚥通過時間較治療前均縮短[(0.14 ±0.07)s對(0.22 ±0.04)s、(0.14±0.08)s對(0.22 ±0.06)s、(0.16 ±0.05)s對(0.21 ±0.08)s、(0.19 ±0.09)s對(0.23±0.10)s,均P＜0.05],A組、B組及C組的嚥通過時間顯著短于D組(P＜0.05),A組、B組的嚥通過時間亦短于C組,但A組與B組間差異無統計學意義(P＞0.05).治療終點時,A、B、C、D4組VFSS有效率分彆為91.66％、91.66％、83.33％、58.33％,A組、B組及C組的有效率顯著優于D組(P＜0.05),A組、B組的有效率亦顯著優于C組(P＜0.05),但A組與B組間差異無統計學意義(P＞0.05).結論 早期介入導尿管毬囊擴張術可有效改善腦卒中後環嚥肌失弛緩癥患者的吞嚥功能,提高其生活質量.
목적 관찰도뇨관구낭확장술개입시간불동대뇌졸중후배인기실이완증료효적영향.방법 선취경전시X선투시탄인공능검사(VFSS)진단위뇌졸중후배인기실이완증적탄인장애환자48례,근거도뇨관구낭확장술개입시간적불동,장환자분위A、B、C화D4조,매조12례.4조균채용주수방식사구낭충영이확장배인기,동시보이저빈전자격급탄인강복행위치료.분별우치료전화치료종점(회복경구진식혹치료만6주후)채용탄인공능림상평개화VFSS분별대4조환자소수구낭확장차수、인통과시간、탄인장애정도급료효진행평정.결과 치료종점시,4조환자소수구낭확장차수분별위(8.12±4.35)차、(9.68 ±4.26)차、(13.59 ±5.47)차、(19.85 ±8.61)차,A조、B조급C조환자소수적구낭확장차수명현소우D조(P＜0.05),A조、B조환자소수적구낭확장차수역소우C조(P＜0.05),단A조여B조간차이무통계학의의(P＞0.05).치료종점시,A조화B조균유11례환자가진식수、류질물、호상물급고체식물,이C조가진식상술4충성상식물적환자분별위9、9、10화9례,D조칙분별위6、6、7、5례,A조、B조급C조적탄인공능균우우D조(P＜0.05),A조、B조적탄인공능역현저우우C조(P＜0.05),단 A조여B조간차이무통계학의의(P＞0.05).A、B、C、D 4조환자치료후적인통과시간교치료전균축단[(0.14 ±0.07)s대(0.22 ±0.04)s、(0.14±0.08)s대(0.22 ±0.06)s、(0.16 ±0.05)s대(0.21 ±0.08)s、(0.19 ±0.09)s대(0.23±0.10)s,균P＜0.05],A조、B조급C조적인통과시간현저단우D조(P＜0.05),A조、B조적인통과시간역단우C조,단A조여B조간차이무통계학의의(P＞0.05).치료종점시,A、B、C、D4조VFSS유효솔분별위91.66％、91.66％、83.33％、58.33％,A조、B조급C조적유효솔현저우우D조(P＜0.05),A조、B조적유효솔역현저우우C조(P＜0.05),단A조여B조간차이무통계학의의(P＞0.05).결론 조기개입도뇨관구낭확장술가유효개선뇌졸중후배인기실이완증환자적탄인공능,제고기생활질량.
Objective To investigate the effect of different intervention times on the efficacy of catheter balloon dilatation therapy for cricopharyngea] achalasia after stroke.Methods Forty-eight cases diagnosed as cricopharyngeal achalasia were divided into 4 groups,groups A,B,C,and D according to the time of intervention from the onset (i.e.0.5,0.5-1,1-3,and 3-6 months),with 12 cases in each group.A 14# urethral catheter was inserted into the esophagus and water was injected into the balloon to make it turgid.The catheter was then pulled upwards through the stricture in the esophagus to dilatate the cricopharygeal muscle.The patients also received low frequency electrical stimulation combined with dysphagia rehabilitation behavioral therapy once daily.The treatment end point was either when the patient resumed an oral diet or after 6 weeks of treatment.The effects of the treatment were evaluated in terms of the number of times the dilatation therapy was administered,the pharyngeal transit duration,swallowing function and fluoroscopic examination before and after treatment.Results Groups A,B and C required significantly fewer treatment sessions than group D.Groups A and B required significantly fewer sessions than group C,but the difference between groups A and B was not statistically significant.After treatment,there were 11 patients can eat water,liquid,paste and solid food both in groups A and B.But the number of patients who can eat the4 traits of food was 9,9,10,9 in group C and 6,6,7,5 in group D respectively.Swallowing function in groups A,B and C was adjudged,on average,significantly better than in group D.Compared with group C,swallowing function in groups A and B was also significantly improved,but the difference between groups A and B was not statistically significant.The pharyngeal transit duration in all 4 groups was shorter than before treatment,but the duration in groups A,B and C was significantly shorter than in group D.Compared with group C,the pharyngeal transit duration in groups A and B was significantly shorter,but the difference between groups A and B was again not statistically significant.Fluoroscopy showed the efficiency in groups A and B to be over 91 ％.In group C it was 83％ and in group D 58％.The difference between group D and groups A,B and C was significant.The efficiency in groups A and B was significantly better than in group C,but the difference between groups A and B again was not statistically significant.Conclusions Early intervention using catheter balloon dilatation therapy can facilitate the improvement of swallowing function in patients with cricopharyngeal achalasia after stroke and improve their quality of life.
