K点刺激、多点负压刺激联合吞咽训练治疗重症颅脑损伤吞咽功能障碍的临床观察

Clinical observation of K-point stimulation, negative-pressure multi-point stimulation combined with swallowing training in the treatment of dysphagia in patients with severe craniocerebral injury

摘要:

目的 观察K点刺激、多点负压刺激联合吞咽训练治疗重症颅脑损伤吞咽功能障碍的临床疗效。方法 选取2019年10月—2021年9月武汉市第一医院收治的92例重症颅脑损伤吞咽功能障碍患者为研究对象，随机分为研究组、对照组，每组46例。对照组采取吞咽训练治疗，研究组在对照组基础上予以K点刺激和多点负压刺激，两组均持续治疗4周后评价效果。对比两组患者治疗前后吞咽功能［洼田饮水试验（WST）、X射线透视功能检查（VFSS）］、临床疗效、表面肌电图（sEMG）变化、吞咽障碍生活质量量表（ED-QOL）评分及营养状况［白蛋白（Alb）、血清总蛋白（TP）］。结果 研究组治疗后WST评分的下降程度大于对照组（P <0.05），VFSS评分的差值高于对照组（P <0.05）。研究组临床疗效、总有效率优于对照组（P <0.05）。研究组治疗前后sEMG最大波幅值的差值高于对照组（P <0.05），吞咽时间的下降程度大于对照组（P <0.05）。研究组治疗前后ED-QOL评分的下降程度大于对照组（P <0.05）。研究组治疗前后血清Alb、TP的差值高于对照组（P <0.05）。结论 K点刺激、多点负压刺激联合吞咽训练治疗重症颅脑损伤吞咽功能障碍可改善患者吞咽功能、临床疗效，提高sEMG波幅、生活质量，缩短吞咽时间，并有利于改善患者的营养状况。

Abstract:

Objective To observe the clinical efficacy of K-point stimulation, negative-pressure multi-point stimulation combined with swallowing training in the treatment of dysphagia in patients with severe craniocerebral injury.Methods A total of 92 patients with severe craniocerebral injury and dysphagia who were admitted to our hospital from October 2019 to September 2021 were selected and randomly divided into a study group and a control group, with 46 cases in each group. The control group was treated with swallowing training, and the study group was additionally given K-point stimulation and negative-pressure multi-point stimulation on the basis of the swallowing training. The effects of both groups were evaluated after continuous treatment for 4 weeks. The changes in swallowing function evaluated via Water Swallow Test (WST) and Videofluoroscopic Swallow Study (VFSS), clinical efficacy, surface electromyography (sEMG), eating disorders quality of life scale (ED-QOL) score and nutritional status [ albumin (Alb) and serum total protein (TP) ] before and after the treatment were compared between the two groups.Results The decrease in the WST score after treatment of the study group was lower than that of the control group (P < 0.05), and the difference in VFSS score before and after the treatment was higher than that of the control group (P < 0.05). The clinical efficacy and total effective rate of the study group were higher than those of the control group (P < 0.05). The difference in the maximum amplitude of sEMG before and after the treatment in the study group was higher than that in the control group (P < 0.05), and the decrease in the swallowing time after treatment was higher than that in the control group (P < 0.05). The decrease in the ED-QOL score after treatment of the study group was lower than that of the control group (P < 0.05). The difference in the serum Alb and TP levels before and after the treatment in the study group were higher than those in the control group (P < 0.05).Conclusions K-point stimulation, negative-pressure multi-point stimulation combined with swallowing training can improve swallowing function, clinical efficacy, sEMG amplitude, and quality of life, shorten the swallowing time, and enhance the nutritional status of patients with severe craniocerebral injury and dysphagia.