摘要
目的 探究六字诀联合吞咽训练治疗脑卒中后吞咽障碍的疗效及对患者吞咽功能、体重指数(BMI)、血清白蛋白(ALB)、血红蛋白(Hb)、衰老关键蛋白抗原-5(Fibulin-5)、血管内皮生长因子(VEGF)水平的影响.方法 选择湖南省人民医院2023年1-10月收治的脑卒中后吞咽障碍患者60例,采用随机数表法分为观察组(n=30,六字诀联合吞咽训练治疗)和对照组(n=30,吞咽训练治疗),疗程4周.对比两组疗效、并发症情况,治疗前、治疗4周通过藤岛一郎吞咽困难分级量表评分、洼田饮水试验(WST)分级、吞咽造影检查(VFSS)评分评价患者吞咽功能,并测定对比营养相关指标及血清Fibulin-5、VEGF水平.结果 观察组治疗总有效率为93.33％(28/30),显著高于对照组73.33％(22/30),差异有统计学意义(x2=4.320,P＜0.05).治疗4周后,观察组藤岛一郎吞咽困难分级量表评分、VFSS评分均显著高于对照组,WST分级显著低于对照组,差异均有统计学意义(t=5.952、6.306、5.777,P均＜0.05).治疗4周后,观察组BMI、ALB、Hb、VEGF水平均显著高于对照组,Fibulin-5显著低于对照组,差异均有统计学意义(t=7.939、4.686、3.760、8.134、6.685,P均＜0.05).治疗4周后,两组肱三头肌皮褶厚度、健侧上臂中部肌围及治疗期间并发症总发生率比较差异均无统计学意义(P均＞0.05).结论 六字诀联合吞咽训练治疗脑卒中后吞咽障碍安全有效,在调控机体吞咽功能、营养状况及血清Fibulin-5、VEGF水平上有优势.
Abstract
Objective To explore the efficacy of six-character formula combined with swallowing training on dysphagia after stroke and its influence on swallowing function,body mass index(BMI),serum albumin(ALB),hemoglobin(Hb),fibulin-5,vascular endothelial growth factor(VEGF)levels.Methods A total of 60 patients with dysphagia after stroke admitted to the Hunan People's Hospital from January 2023 to October 2023 were selected and divided into the observation group(n=30,six-character formula combined with swallowing training treatment)and the control group(n=30,swallowing training treatment)by the random number method,with a treatment course of 4 weeks.The efficacy and complications of the two groups were compared.Before treatment and 4 weeks after treatment,the swallowing function of the patients was evaluated by dysphagia grading scale,water swallowing test(WST)classification and video fluoroscopic swallowing study(VFSS)score,and the related indexes of nutrition,serum fibulin-5 and VEGF levels were determined.Results The total effective rate in the observation group was 93.33％(28/30),which was significantly higher than 73.33％(22/30)in the control group,the differences was statistically significant(x2=4.320,P＜0.05).After 4 weeks of treatment,the score of dysphagia grading scale and VFSS in the observation group was significantly higher,while the WST classification significantly decreased and the score in the observation group was lower,the differences were statistically significant(t=5.952,6.306,5.777;all P＜0.05).After 4 weeks of treatment,the levels of BMI,ALB,Hb and VEGF in the observation group were higher than those control group,fibulin-5 level of the observation group was lower than that of the control group,the differences were statistically significant(t=7.939,4.686,3.760,8.134,6.685,all P＜0.05).There were no statistically significant differences in triceps skin-fold thickness(TSF),middle upper arm muscle circumference(AMC)and the incidence of complications between the two groups after 4 weeks of treatment(P＞0.05).Conclusions Six-character formula combined with swallowing training was safe and effective in the treatment of dysphagia after stroke and had advantages in regulating swallowing function,nutritional status,serum fibulin-5 and VEGF levels.
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