一种吞咽障碍压力测定与扩张治疗仪对脑卒中后环咽肌失弛缓症患者的临床疗效分析

关键词：环咽肌失弛缓  压力测量  扩张治疗  吞咽障碍  吞咽造影检查

Keywords:cricopharyngeal achalasia  pressure measurement  dilation therapy  dysphagia  video fluoroscopic swallowing study

摘要：

      摘要 目的：研究一种吞咽障碍压力测定与扩张治疗仪对脑卒中后环咽肌失弛缓症患者的临床治疗效果。 方法：收集2016—2018年我科住院的脑卒中后环咽肌失弛缓症患者30例，按随机数字表法将其分为试验组15例，对照组15例。两组给予常规康复训练的同时，试验组采用自制吞咽障碍压力测定与扩张治疗仪对环咽肌进行扩张，对照组采用传统导尿管球囊扩张术对环咽肌进行扩张。治疗前后评估两组患者吞咽功能变化、扩张次数及并发症的发生情况。 结果：治疗后，试验组恢复经口进食11例(73.3%)，对照组恢复经口进食12例(80.0%)，其差异无显著性意义(P>0.05)；试验组藤岛一郎吞咽疗效评分为(7.00±2.56)分，对照组为(7.13±2.20)分，两组组内治疗前后比较，差异均有显著性意义(P<0.05)，两组间差异无显著性意义(P>0.05)；治疗后两组患者VFSS评分在口腔期、咽期、误吸及总分与组内治疗前比较，差异均有显著性意义(P<0.05)，两组间差异无显著性意义(P>0.05)。试验组进行环咽肌的扩张次数为（5.67±1.04）次，对照组为（10.33±2.32）次，试验组次数少于对照组，差异有显著性意义(P<0.05)。试验组患者发生粘膜出血、喉头水肿、咽喉部疼痛等并发症分别为1例、1例、（1.07±0.26）分，对照组分别为12例、11例、（2.20±0.68）分，差异有显著性意义(P<0.05)；试验组环咽肌压力较治疗前明显降低。 结论：自制吞咽障碍压力测定与扩张治疗仪对脑卒中后环咽肌失弛缓症患者的临床疗效肯定，扩张次数和局部部位不良反应少于传统导尿管球囊扩张术的患者，有较强的临床实用性。

Abstract:

      Abstract Objective：To investigate the clinical effects of a swallowing disorder pressure measurement and treatment equipment for patients with cricopharyngeal achalasia. Method：Thirty patients with cricopharyngeal achalasia after stroke in our department from 2016 to 2018 were divided into the experimental group (n=15) and the control group (n=15) randomly.Both groups received conventional rehabilitation training. The experimental group was treated with the swallowing disorder pressure measurement and treatment equipment, while the control group was treated with catheter balloon dilatation therapy. Before and after treatment，the changes of swallowing function,the times of dilatation and the incidence of complications in the two groups were evaluated. Result：After treatment, 11 of the 15 patients (73.3%) in the experimental group regained the ability to take solid food and water orally, while 12 of the 15 patients in control group regained the ability to take solid food and water orally. There was no significant difference between the two groups（P>0.05）.The swallowing efficacy score of Ichiro Fujishima was 7.00±2.56 in the experimental group；which was 7.13±2.20 in the control group. After treatment, the scores in both groups were significantly higher than those before treatment （P<0.05）. Compared the both groups after treatment, there was no significant difference between the two groups（P>0.05）. After treatment, the VFSS scores of patients in the oral stage, pharyngeal stage, aspiration and total score were significantly higher than those before treatment（P<0.05）. Compared the both groups after treatment, there was no significant difference between the two groups（P>0.05）. The number of cricopharyngeal muscle dilatation in the experimental group was 5.67±1.04 , and 10.33±2.32 in the control group，with statistically significant difference(P<0.05).The complications of mucosal hemorrhage, laryngeal edema and sore throat in the experimental group were 1, 1, (1.07± 0.26), and 12, 11, (2.20 ±0.68), respectively, and the difference was statistically significant when compared with control group(P<0.05).In the experimental group, the cyclopharyngeal muscle pressure was significantly lower than that before treatment Conclusion: The clinical effects of a swallowing disorder pressure measurement and treatment equipment has a positive clinical effect on the patients with cricopharyngeal achalasia after stroke. And the number of dilatation and local adverse reactions is less than that of the patients with traditional catheter balloon dilatation, which has a strong clinical practicability.