CAJ | 학술논문

目的探讨冰水、常温水球囊扩张对脑干卒中后环咽肌失弛缓症的治疗作用,并进行疗效对比.方法根据入院时间将脑干卒中后环咽肌失弛缓患者(40例)分为2组,实验组患者给予冰水球囊扩张及低频电刺激治疗,对照组则给予常温水球囊扩张及低频电刺激治疗.于治疗前、治疗4周后对2组患者吞咽功能进行评定.结果治疗后2组共有36例患者可独立自主进食糊状食物,电视X线透视吞咽功能检查(VFSS)显示食团在通过咽喉时,其环咽肌均正常开放,食物能顺利通过环咽肌,误吸消失.通过组间比较发现,治疗后2组患者环咽肌开放情况、留置鼻胃管例数、正常进食例数及功能性经口进食量表评分(FOIS)组间差异均无统计学意义(Pp＞0.05),但实验组平均治疗次数[(7.45±2.3)次/例]、平均住院天数[(16.7±4.8)d/例]、平均治疗费用[(6430±874)元/例]均显著优于对照组水平,组间差异均具有统计学意义(P＜0.05).结论冰水球囊扩张或常温水球囊扩张联合低频电刺激均能有效改善脑干卒中后环咽肌失弛缓导致的吞咽障碍,并且与常温水球囊扩张联合低频电刺激比较,冰水球囊扩张联合低频电刺激能进一步缩短疗程,减轻患者经济负担,该疗法值得临床推广、应用.
목적 탐토빙수、상온수구낭확장대뇌간졸중후배인기실이완증적치료작용,병진행료효대비.방법 근거입원시간장뇌간졸중후배인기실이완환자(40례)분위2조,실험조환자급여빙수구낭확장급저빈전자격치료,대조조칙급여상온수구낭확장급저빈전자격치료.우치료전、치료4주후대2조환자탄인공능진행평정.결과 치료후2조공유36례환자가독립자주진식호상식물,전시X선투시탄인공능검사(VFSS)현시식단재통과인후시,기배인기균정상개방,식물능순리통과배인기,오흡소실.통과조간비교발현,치료후2조환자배인기개방정황、류치비위관례수、정상진식례수급공능성경구진식량표평분(FOIS)조간차이균무통계학의의(Pp＞0.05),단실험조평균치료차수[(7.45±2.3)차/례]、평균주원천수[(16.7±4.8)d/례]、평균치료비용[(6430±874)원/례]균현저우우대조조수평,조간차이균구유통계학의의(P＜0.05).결론 빙수구낭확장혹상온수구낭확장연합저빈전자격균능유효개선뇌간졸중후배인기실이완도치적탄인장애,병차여상온수구낭확장연합저빈전자격비교,빙수구낭확장연합저빈전자격능진일보축단료정,감경환자경제부담,해요법치득림상추엄、응용.
Objective To observe the therapeutic effects of balloon dilatation with ice water and room temperature water on cricopharyngeal achalasia after brainstem stroke.Methods Forty dysphagic patients with cricopharyngeal achalasia after brainstem stroke were recruited.Twenty patients assigned to experimental group were treated by balloon dilatation with ice water and low frequency elecrtrical stimulation.Twenty patients assigned to control group were treated by balloon dilatation with room temperature water and low frequency electrical stimulation.Results After treatment,36 out of the 40 patients of the two groups could eat pasty food independently without choking.Videofluoroscopic swallowing study (VFSS) showed that the cricopharyngeal sphincter relaxed and the foods passed successfully when swallowing bolus,and no aspiration happened.In comparison,the level of cricopharyngeal opening,the number of patients with nasogastric tube remained and eating normally,and the scores of functional oral intake scale (FOIS) between the two groups showed no significant difference (P ＞ 0.05).The average treatment sessions,average hospitalization days and average treatment cost in treatment group were significantly less than those in the control group(P ＜0.05).Conclusion Cricopharyngeal achalasia can be treated effectively by balloon dilatation with ice water or with room temperature water combined with low frequency electrical stimulation,but treatment course of balloon dilatation with ice water were significantly shorter than that of balloon dilatation with room temperature water.