“六字诀”训练联合吞咽功能训练对脑卒中后吞咽障碍的疗效观察

Observation on the Efficacy of “Liu Zi Jue” Training Combined with Swallowing Function Training on Post-Stroke Dysphagia

摘要: 目的：探讨“六字诀”训练联合吞咽功能训练对脑卒中后吞咽障碍患者吞咽功能及呼吸协调性的临床疗效。方法：采用随机数字表法将90例脑卒中后吞咽障碍患者分为对照组(n = 45)和观察组(n = 45)。对照组接受常规吞咽功能训练(包括口腔感觉训练、门德尔松吞咽法、声门上吞咽法、神经肌肉电刺激)，观察组在对照组基础上增加“六字诀”训练。两组均每日训练1次，每周5天，持续8周。于治疗前及治疗8周后，采用视频荧光吞咽功能检查(VFSS)量表、进食评估问卷-10 (EAT-10)及患侧膈肌活动度超声测量评估疗效。结果：治疗后，两组VFSS评分、EAT-10评分及膈肌活动度均较治疗前显著改善(P < 0.05)。观察组治疗后VFSS评分(9.62 ± 0.68)分、EAT-10评分(2.38 ± 2.35)分及膈肌活动度(1.51 ± 0.30)cm，均显著优于对照组(8.40 ± 1.52)分、(5.85 ± 5.10)分、(1.32 ± 0.28) cm，差异有统计学意义(P < 0.05)。结论：“六字诀”训练联合吞咽功能训练可更有效改善脑卒中后吞咽障碍患者的吞咽功能、主观进食体验及膈肌功能，其机制可能与优化呼吸–吞咽协调性有关。

Abstract: Objective: To explore the clinical efficacy of “Liu Zi Jue” training combined with swallowing function training on swallowing function and respiratory coordination in patients with post-stroke dysphagia. Methods 90 patients with post-stroke dysphagia were divided into a control group (n = 45) and an observation group (n = 45) using the random number table method. The control group received conventional swallowing function training (including oral sensory training, Mendelssohn swallowing method, supraglottic swallowing method, and neuromuscular electrical stimulation), while the observation group added “Liu Zi Jue” training on the basis of the control group. Both groups trained once a day, 5 days a week, for 8 weeks. Before treatment and after 8 weeks of treatment, the video fluorescence swallowing function test (VFSS) scale, eating assessment questionnaire-10 (EAT-10) and ultrasound measurement of diaphragm activity on the affected side were used to evaluate the efficacy. Results: After treatment, the VFSS score, EAT-10 score and diaphragm activity in both groups were significantly improved compared with before treatment (P < 0.05). After treatment, the VFSS score (9.62 ± 0.68), EAT-10 score (2.38 ± 2.35) and diaphragm activity (1.51 ± 0.30) cm of the observation group were significantly better than those of the control group (8.40 ± 1.52), (5.85 ± 5.10) and (1.32 ± 0.28) cm, and the difference was statistically significant (P < 0.05). Conclusion: “Liu Zi Jue” training combined with swallowing function training can more effectively improve the swallowing function, subjective eating experience and diaphragm function of patients with post-stroke dysphagia. The mechanism may be related to optimizing breathing-swallowing coordination.