本文選題：導(dǎo)尿管球囊擴(kuò)張術(shù)　切入點(diǎn)：腦卒中　出處：《鄭州大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的 觀(guān)察導(dǎo)尿管球囊擴(kuò)張術(shù)對(duì)腦卒中后環(huán)咽肌失弛緩造成吞咽功能障礙的療效。 方法 本研究選取2013年2月至2014年2月期間在鄭州大學(xué)第一附屬醫(yī)院康復(fù)醫(yī)學(xué)科住院的32例腦卒中后環(huán)咽肌失弛緩造成吞咽功能障礙的患者。采用隨機(jī)數(shù)字表法,將符合標(biāo)準(zhǔn)的患者隨機(jī)分為治療組和對(duì)照組，各16例。兩組患者均給予常規(guī)康復(fù)治療，包括吞咽基礎(chǔ)訓(xùn)練、攝食訓(xùn)練、Vitalstim電刺激治療、針灸療法、經(jīng)顱磁刺激治療。治療組患者在給予常規(guī)康復(fù)治療的基礎(chǔ)上加用導(dǎo)尿管球囊擴(kuò)張術(shù)治療。常規(guī)康復(fù)治療每日1次，每周治療6d，導(dǎo)尿管球囊擴(kuò)張術(shù)治療每日2次，每次8-10遍，每次大約30min，每周治療6d，每次增加0.5～1ml，注水量最大不超過(guò)15ml，兩組的治療終點(diǎn)是恢復(fù)經(jīng)口進(jìn)食或治療達(dá)2周。評(píng)估兩組患者治療前與治療后吞咽障礙程度評(píng)分、吞咽功能評(píng)分、VFSS咽通過(guò)時(shí)間和吞咽功能評(píng)價(jià)。 結(jié)果 兩組患者治療前吞咽障礙程度評(píng)分、吞咽功能評(píng)定和VFSS咽通過(guò)時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）�；颊呓�(jīng)口進(jìn)食或治療時(shí)間達(dá)2周后兩組患者的吞咽障礙程度評(píng)分和吞咽功能評(píng)定均有改善（P＜0.05），且上述指標(biāo)以治療組的改善更加明顯，，與對(duì)照組比較，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05），治療前與治療后的組內(nèi)比較，差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)�；謴�(fù)經(jīng)口進(jìn)食或治療達(dá)2周后治療組咽通過(guò)時(shí)間比對(duì)照組明顯縮短（P＜0.05）。治療組治療后比治療前咽通過(guò)時(shí)間明顯縮短(P＜0.05)，治療前后對(duì)照組組內(nèi)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。兩組患者經(jīng)口進(jìn)食或治療2周后，治療組16例患者當(dāng)中有12例患者可以經(jīng)口進(jìn)食水、固體食物及流質(zhì)食物，有14例患者恢復(fù)進(jìn)食糊狀食物。對(duì)照組16例患者，恢復(fù)進(jìn)食水、固體食物及流質(zhì)食物的有5例，進(jìn)食糊狀食物的有9例。兩組患者吞咽功能比較，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 結(jié)論 使用改進(jìn)方案后的導(dǎo)尿管球囊擴(kuò)張術(shù)治療腦卒中后環(huán)咽肌失弛緩所導(dǎo)致的吞咽功能障礙與常規(guī)治療方法相比，明顯縮短了治療時(shí)間，在短時(shí)間內(nèi)提高患者的進(jìn)食能力，是一種更加有效的治療方法，值得在臨床中推廣。
[Abstract]:Purpose. To observe the effect of balloon dilatation of urethral catheter on dysphagia caused by achalasia of cricopharynx muscle after stroke. Method. From February 2013 to February 2014, 32 patients with dysphagia caused by achalasia after stroke were enrolled in the Department of Rehabilitation Medicine of the first affiliated Hospital of Zhengzhou University. The patients who met the standard were randomly divided into treatment group (n = 16) and control group (n = 16). The patients in both groups were given routine rehabilitation therapy, including basic swallowing training, feeding training and Vitalstim electric stimulation, acupuncture therapy. The patients in the treatment group were treated with catheter balloon dilatation on the basis of routine rehabilitation therapy. Routine rehabilitation therapy was performed once a day, 6 days a week, and 2 times a day, 8-10 times each time. Patients in each group were treated for about 30 minutes for 6 days per week, with an increase of 0.5ml per week, with a maximum injection of no more than 15ml. The end point of treatment in both groups was to resume oral feeding or treatment for up to 2 weeks. Evaluate the degree of dysphagia before and after treatment in both groups. The score of swallowing function was evaluated by VFSS through time and swallowing function. Results. The score of degree of dysphagia before treatment in the two groups, There was no significant difference in swallowing function and VFSS's pharyngeal transit time between the two groups (P < 0.05). After oral feeding or treatment for 2 weeks, the scores of deglutition disorder and the evaluation of swallowing function were improved in both groups (P < 0.05), and the above indexes were treated. The improvement in the treatment group was more obvious. Compared with the control group, the difference was statistically significant (P < 0.05). The difference was statistically significant (P < 0.05). The pharynx passage time of the treatment group was significantly shorter than that of the control group after the recovery of oral feeding or treatment for 2 weeks (P < 0.05). The pharyngeal passage time of the treatment group was significantly shorter than that of the pre-treatment group (P < 0.05), and that of the control group before and after treatment was significantly shorter than that of the control group (P < 0.05). There was no significant difference between the two groups (P > 0.05). After two weeks of oral feeding or treatment, 12 of the 16 patients in the treatment group could eat water, solid food and liquid food through mouth. In the control group, there were 16 patients, 5 patients returned to water, solid food and liquid food, and 9 patients ate paste food. There was a significant difference in swallowing function between the two groups (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). Conclusion. The treatment of dysphagia caused by retrograde catheter balloon dilatation after stroke was significantly shorter than that of conventional therapy, and the feeding ability of patients was improved in a short time. It is a more effective treatment method and is worth popularizing in clinic.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3

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