导尿管球囊扩张术治疗脑干卒中后环咽肌失弛缓症的疗效观察及对卒中后吸入性肺炎的影响

关键词：脑干卒中  球囊扩张术  Shaker训练  环咽肌失弛缓症  吸入性肺炎

Keywords:brainstem stroke  balloon dilation  Shaker training  cricopharyngeal achalasia  aspiration pneumonia

摘要：

      摘要 目的：观察导尿管球囊扩张术及高强度Shaker训练对脑干卒中后环咽肌失弛缓症的疗效及对卒中后吸入性肺炎的影响。 方法：选择羊坊店医院及望京医院2022年7月—2022年12月接收的50例脑干卒中后有吞咽障碍患者，本试验为非盲临床试验，按入院先后顺序及接受球囊扩张将患者分为对照组（25例）、试验组（25 例）。对照组进行常规吞咽治疗，并且加大Shaker训练强度，试验组比对照组增加经口球囊扩张术治疗。运用吞咽功能造影检查（VFSS），标准吞咽功能评价量表（SSA）、Rosenbek渗透/误吸量表、进食功能及吸入性肺炎发生率对比吞咽功能的变化及吸入性肺炎发病率的变化，抑郁自评量表（SDS）及焦虑自评量表（SAS）评定患者心理状态变化。 结果：两组患者在治疗前吞咽功能及心理状态比较无显著性意义（P>0.05）。经过8周治疗后两组患者SSA、VFSS、Rosenbek评分均得到改善（P<0.05），SAS、SDS评分均明显下降，进食功能明显进步，两组吞咽及心理状态均较治疗前改善，且试验组明显高于对照组（P<0.05）。 结论：加大Shaker训练强度的吞咽康复训练方法以及球囊扩张对吞咽障碍的恢复都有效，但是两者联合治疗效果更佳，两组治疗后Rosenbek评分及吸入性肺炎发生率与治疗前相比均有改善，表明加大Shaker训练强度的康复训练以及球囊扩张均能有效减少吸入性肺炎的出现，联合球囊扩张效果更佳。

Abstract:

      Abstract Objective： To observe the therapeutic effects of catheter balloon dilation and high-intensity Shaker training on cricopharyngeal achalasia after brainstem stroke and the effect on post-stroke aspiration pneumonia. Method： Fifty patients with swallowing disorders after brainstem stroke admitted to Yangfangdian Hospital and Wangjing Hospital between July 2022 and December 2022 were selected for this non-blinded clinical trial. The patients were divided into the control group （n=25） and the experimental group （n=25） according to the order of admission and receipt of balloon dilation. The control group was treated with conventional swallowing therapy and increased the intensity of Shaker training， while the experimental group was treated with additional transoral balloon dilatation. The changes of swallowing function and incidence of aspiration pneumonia were compared using videofluoroscopic swallowing study（VFSS）， the standard swallowing function assessment scale （SSA）， Rosenbek infiltration/misaspiration scale， feeding function and the incidence of aspiration pneumonia. The self-assessment depression scale （SDS） and anxiety self-assessment anxiety scale （SAS） were used to assess the changes of patients' psychological status. Result： There was no statistically significant differences in swallowing function and psychological status between the two groups before treatment （P>0.05）. After 8 weeks of treatment， both groups showed improvement in SSA， VFSS and Rosenbek scores （P<0.05）， and significant reductions in SAS and SDS, with significant improvement in feeding function. The improvement in swallowing and psychological status of both groups was better than pre-treatment， with significantly higher in the experimental group than the control group （P<0.05）. Conclusion： Both the rehabilitation training method of swallowing with increasing the intensity of Shaker training and balloon dilation are effective in the recovery of swallowing disorder， but the combined treatment is more effective. Both group showed improvements in Rosenbek score and reduced incidence of aspiration after treatment， indicating that the rehabilitation training with increasing intensity of Shaker training and balloon dilation can effectively reduce the incidence of aspiration pneumonia， and the combined treatment was more effective.