放射式体外冲击波疗法联合摄食-吞咽训练在老年脑卒中后吞咽障碍患者康复治疗中的应用初探

Preliminary study on application of radial extracorporeal shock wave therapy combined with ingestion-swallowing training in rehabilitation treatment of elderly patients with post-stroke dysphagia

中文关键词: 老年  脑卒中  吞咽障碍  放射式体外冲击波疗法  摄食-吞咽训练

英文关键词: elderly  stroke  dysphagia  radial extracorporeal shock wave therapy  ingestion-swallowing training

中文摘要:

      目的 探讨放射式体外冲击波疗法(rESWT)联合摄食-吞咽训练在老年脑卒中后吞咽障碍(PSD)中的应用效果.方法 选取2022年3月至2023年12月西安高新医院收治的老年PSD患者116例,按随机数表法均分为对照组(n=58,接受摄食-吞咽训练)和联合组(n=58,接受rESWT联合摄食-吞咽训练),连续干预4周.比较2组白蛋白、血红蛋白、转铁蛋白、前白蛋白水平、脑源性神经营养因子(BDNF)、神经生长因子(NGF)水平、最大峰值流速(PSV)、平均流速(MFV)、血管阻力指数(RI)、吞咽功能等级(洼田饮水试验).结果 干预前,对照组、观察组的吞咽功能分别为3级8例、4级32例、5级18例,3级6例、4级29例、5级23例;干预后均显著改善,分别为2级22例、3级19例、4级9例、5级8例,1级12例、2级32例、3级8例、4级5例、5级1例.干预后联合组血清白蛋白、血红蛋白、转铁蛋白、白蛋白、BDNF、NGF、PSV、MFV均高于对照组(P＜0.05);RI低于对照组(P＜0.05).结论 rESWT联合摄食-吞咽训练能有效改善老年PSD患者的营养、神经功能、脑血流动力学和吞咽障碍,尤其适合共病多、康复需求高的老年人群.

英文摘要:

      Objective To investigate the effects of radial extracorporeal shock wave therapy(rESWT)combined with ingestion-swallowing training on elderly patients with post-stroke dysphagia(PSD).Methods A total of 116 elderly PSD patients admitted to Xi'an High-Tech Hospital from March 2022 to December 2023 were selected and randomly divided into control group(n=58,receiving ingestion-swallowing training)and combination group(n=58,receiving rESWT combined with ingestion-swallowing training)using random number table method.Both groups received continuous intervention for 4 weeks.The levels of albumin,hemoglobin,transferrin,prealbumin,brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),peak systolic velocity(PSV),mean flow velocity(MFV),vascular resistance index(RI),and swallowing function grade(assessed by the Wada Water Swallowing Test)were compared between the two groups.Results Before intervention,there were 8 cases with swallowing function at grade 3,32 cases at grade 4,and 18 cases at grade 5 in the control group;6 cases at grade 3,29 cases at grade 4,and 23 cases at grade 5 in the combination group.After intervention,both groups showed significant improvement:grade 2(22 cases),grade 3(19 cases),grade 4(9 cases)and grade 5(8 cases)in the control group;grade 1(12 cases);grade 2(32 cases),grade 3(8 cases),grade 4(5 cases)and grade 5(1 case)in the combination group.After intervention,the levels of serum albumin,hemoglobin,transferrin,prealbumin,BDNF,NGF,PSV,and MFV in the combination group were significantly higher than those in the control group(P＜0.05),while the RI was significantly lower(P＜0.05).Conclusion The combination of rESWT and ingestion-swallowing training can effectively improve nutritional status,neurological function,cerebral hemodynamics,and swallowing function in elderly PSD patients.This approach is particularly suitable for elderly patients with multiple comorbidities and high rehabilitation needs.