多巴丝肼联合呼吸训练在卒中后吞咽困难中的效果评价

doi:10.11958/20241777

摘要/Abstract

摘要：

目的探究多巴丝肼联合呼吸训练对卒中后吞咽困难的治疗效果。方法前瞻性选取120例卒中后吞咽困难患者为研究对象，随机分为联合组和呼吸训练组，每组60例。呼吸训练组采用康复呼吸训练，联合组在此基础上加用多巴丝肼进行治疗。比较2组中医证候积分、临床疗效、吞咽功能指标[吞咽障碍造影评分表（VDS）评分、渗透-误吸量表（PAS）评分、洼田饮水试验评分、X线电视透视法（VFSS）评分]；营养指标[总胆固醇（TC）、甘油三酯（TG）、白蛋白（ALB）、血红蛋白（Hb）]；神经功能相关指标[血清生长分化因子15（GDF-15）、中枢神经特异蛋白可溶性蛋白-100β（S100β）]；生活质量及焦虑障碍评分[生活质量评分量表（SF-36）评分、广泛性焦虑障碍量表（GAD-7）评分]及不良反应。结果联合组总有效率高于呼吸训练组（P<0.05）；与治疗前相比，治疗后2组舌痿缩、吞咽缓慢、饮水发呛、舌苔瘀斑、脉搏细涩评分、VDS、PAS、洼田饮水试验评分、GDF-15水平、GAD-7评分均降低，联合组低于呼吸训练组（P<0.05）；2组TC、TG、ALB、Hb、S100β水平，VFSS、SF-36评分均升高，联合组高于呼吸训练组（P<0.05）；2组不良反应发生率差异无统计学意义。结论多巴丝肼联合呼吸训练可有效改善卒中后吞咽困难患者中医证候积分及营养指标，增强吞咽功能，降低焦虑情绪，提高生活质量，疗效显著。

关键词: 卒中, 吞咽障碍, 呼吸锻炼, 多巴丝肼, 效果评价

Abstract:

Objective To investigate the effect of benserazide combined with respiratory training on post-stroke dysphagia. Methods A total of 120 patients with dysphagia after stroke were prospectively selected and randomly divided into the combination group and the breathing exercise group, with 60 cases in each group. The breathing exercise group was treated with rehabilitation breathing training, and the combination group was treated with dopa serazide on the basis of rehabilitation breathing training, 3 times a day, 1 tablet once. The traditional Chinese medicine (TCM) syndrome scores, clinical efficacy and swallowing function indexes including dysphagia angiography score (VDS), osmotic-aspiration scale (PAS) score, Lowada drinking water test score and VFSS score were compared between the two groups. Nutritional indices [total cholesterol (TC), triglyceride (TG), albumin (ALB), hemoglobin (Hb)], related indexes of nerve function [nerve function and serum growth differentiation factor 15 (GDF-15), central nerve specific protein soluble protein-100β (S100β)], quality of life and anxiety disorder score [Quality of Life Rating Scale (SF-36) score, Generalized Anxiety Disorder Scale (GAD-7) score] and adverse reactions were compared between the two groups. Results The total effective rate of the combination group (91.67%) was obviously increased (P<0.05) compared to the breathing exercise group (58.33%). Compared with before treatment, after treatment, tongue flaccidity, slow swallowing, choke after drinking water, tongue coating ecchymosis, score of fine pulse, VDS, PAS, score of Lowada drinking water test, GDF-15 level and GAD-7 score were decreased in the two groups, and those of the combination group were significantly lower than the breathing exercise group (P<0.05). The levels of TC, TG, ALB, Hb, S100β, VFSS and SF-36 were increased in the two groups, and those of the combination group were higher than the breathing exercise group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Benserazide combined with respiratory training has high clinical efficacy in patients with post-stroke dysphagia, which can effectively improve the TCM evidence score and nutritional indicators, improve swallowing function, reduce anxiety, improve quality of life, and have more ideal clinical application.

Key words: stroke, deglutition disorders, breathing exercises, benserazide, effect evaluation

中图分类号:

R969.4

图/表 8

参考文献 19

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组别	性别（男/女）	年龄/ 岁	体质量指数/ （kg/m²）	病程/ 月
呼吸训练组	26/34	62.92±7.05	18.98±2.49	2.45±0.67
联合组	25/35	64.38±6.31	19.35±2.57	2.30±0.74
χ²或t	0.034	1.201	0.800	1.157

组别	性别（男/女）	年龄/ 岁	体质量指数/ （kg/m²）	病程/ 月
呼吸训练组	26/34	62.92±7.05	18.98±2.49	2.45±0.67
联合组	25/35	64.38±6.31	19.35±2.57	2.30±0.74
χ²或t	0.034	1.201	0.800	1.157

组别	舌痿缩					吞咽缓慢					饮水发呛
组别	治疗前		治疗后	t		治疗前		治疗后		t	治疗前		治疗后		t
呼吸训练组	4.75±0.85		3.65±0.59	8.018^＊		5.17±0.87		4.70±0.57		3.501^＊	4.89±0.86		3.93±0.49		8.895^＊
联合组	4.55±0.52		1.31±0.23	43.773^＊＊		5.46±0.76		2.36±0.25		31.317^＊＊	5.16±0.68		2.55±0.28		28.220^＊＊
t	1.477		28.898^＊＊			0.581		28.839^＊＊			1.965		18.660^＊＊
组别		舌苔瘀斑							脉搏细涩
组别		治疗前			治疗后		t		治疗前			治疗后		t
呼吸训练组		2.19±0.27			1.83±0.19		9.004^＊		2.19±0.25			1.87±0.19		7.351^＊
联合组		2.26±0.34			1.01±0.18		25.503^＊＊		2.13±0.20			1.05±0.12		38.222^＊＊
t		1.140			24.285^＊＊				1.403			27.409^＊＊

组别	舌痿缩					吞咽缓慢					饮水发呛
组别	治疗前		治疗后	t		治疗前		治疗后		t	治疗前		治疗后		t
呼吸训练组	4.75±0.85		3.65±0.59	8.018^＊		5.17±0.87		4.70±0.57		3.501^＊	4.89±0.86		3.93±0.49		8.895^＊
联合组	4.55±0.52		1.31±0.23	43.773^＊＊		5.46±0.76		2.36±0.25		31.317^＊＊	5.16±0.68		2.55±0.28		28.220^＊＊
t	1.477		28.898^＊＊			0.581		28.839^＊＊			1.965		18.660^＊＊
组别		舌苔瘀斑							脉搏细涩
组别		治疗前			治疗后		t		治疗前			治疗后		t
呼吸训练组		2.19±0.27			1.83±0.19		9.004^＊		2.19±0.25			1.87±0.19		7.351^＊
联合组		2.26±0.34			1.01±0.18		25.503^＊＊		2.13±0.20			1.05±0.12		38.222^＊＊
t		1.140			24.285^＊＊				1.403			27.409^＊＊

组别	治愈	显效	有效	无效	总有效
呼吸训练组	7（11.67）	13（21.67）	15（25.00）	25（41.67）	35（58.33）
联合组	12（20.00）	18（30.00）	25（41.67）	5（8.33）	55（91.67）
χ²					17.778^＊＊