【摘要】：腦血管疾病(Cerebrovascular Disease,CVD)是因顱內(nèi)血液循環(huán)障礙而造成腦組織損害的一組疾病,其中腦梗死最常見,腦梗死具有高發(fā)病率、高致殘率的特點。我國每年因心腦血管疾病而死亡的人數(shù)大約為260萬,約占總死亡比例的45%[1]。吞咽功能障礙(deglutition disorders orswallowing disorder,DD or SD)是腦梗死患者常見的并發(fā)癥之一,可并伴有發(fā)音含糊不清、費力,可引起誤吸導致肺感染、營養(yǎng)不良、水電解質(zhì)平衡失調(diào)等并發(fā)癥,嚴重地影響腦梗死患者的預后。腦梗死康復是降低致殘率最有效的方法。目前腦梗死后吞咽障礙患者進行吞咽康復訓練已經(jīng)廣泛運用于臨床,并取得較好的臨床療效。可見吞咽障礙的康復治療在腦卒中的康復中至關重要,對縮短病程、減輕患者及家庭社會的負擔、提高患者的生存質(zhì)量、降低死亡率等方面都有顯著的影響。舌壓抗阻反饋訓練是利用舌肌康復器進行吞咽訓練一種吞咽康復方法,其靈感來源于舌骨上抬、前移運動的生理過程,訓練的目標是通過舌壓測定器的壓力數(shù)據(jù)變化,視覺反饋讓患者更容易體會吞咽動作的要領。強化舌肌上抬肌力,增加吞咽時舌骨上抬前移的幅度;增加舌頭的感覺刺激,增強舌頭控制、協(xié)調(diào)能力;增強舌頭運送食物的能力。適用于腦卒中后舌部肌肉力量及協(xié)調(diào)不足。而中醫(yī)作為祖國醫(yī)學的瑰寶,中藥冰棒咽部刺激在吞咽障礙的康復治療中也顯示出獨特的療效。本研究通過臨床治療與觀測,聯(lián)合治療組與單一治療組、對照組比較療效均有顯著差異,聯(lián)合治療組優(yōu)于單一治療組和對照組。希望本課題能為臨床治療提供一個全新的吞咽康復概念,促進吞咽障礙康復治療的發(fā)展,為更多吞咽障礙的患者謀福利。目的:探討舌壓抗阻反饋訓練結(jié)合中藥冰棒咽部刺激治療腦梗死后吞咽障礙的療效。方法:選取腦梗死后吞咽障礙的患者120例,隨機分為3組,每組40例。一般治療組為對照組,給予常規(guī)的吞咽康復訓練治療;治療A組除常規(guī)的吞咽康復訓練治療外還給予中藥冰棒咽部刺激治療;治療B組為聯(lián)合治療組,在治療A組基礎上給予舌壓抗阻反饋訓練治療,比較3組臨床療效。結(jié)果:三個治療組均能改善吞咽障礙,但聯(lián)合治療組的療效更優(yōu)于其他組(P0.05)。結(jié)論:舌壓抗阻反饋訓練結(jié)合中藥冰棒咽部刺激治療腦梗死后吞咽障礙有顯著療效,可縮短治療時間,有效改善吞咽功能,聯(lián)合治療較單一的康復治療的療效更佳。
[Abstract]:Cerebrovascular disease (Cerebrovascular Disease,CVD) is a group of diseases caused by intracranial blood circulation disturbance. Cerebral infarction is the most common one. Cerebral infarction has the characteristics of high incidence and high disability rate. The number of deaths due to cardiovascular and cerebrovascular diseases in China is about 2.6 million, accounting for 45% of the total deaths. Dysphagia (deglutition disorders orswallowing disorder,DD or SD) is one of the common complications in patients with cerebral infarction. It can be accompanied by ambiguous and laborious pronunciation, which can lead to pulmonary infection, malnutrition, water and electrolyte imbalance, etc. The prognosis of patients with cerebral infarction is seriously affected. Rehabilitation of cerebral infarction is the most effective method to reduce disability rate. At present, rehabilitation training has been widely used in patients with dysphagia after cerebral infarction. It can be seen that the rehabilitation treatment of dysphagia is very important in the rehabilitation of stroke, which has a significant effect on shortening the course of disease, lightening the burden of patients and families and society, improving the quality of life of patients, and reducing the mortality rate. Tongue pressure resistance feedback training is a kind of swallowing rehabilitation method using tongue muscle rehabilitation device. Its inspiration comes from the physiological process of hyoid upward and forward movement. The aim of the training is to change the pressure data of tongue pressure tester. Visual feedback makes it easier for patients to experience the essentials of swallowing. Strengthen tongue muscle lift strength, increase the amplitude of hyoid bone lifting forward during swallowing; increase tongue sensory stimulation, enhance tongue control and coordination ability; enhance tongue food delivery ability. It is suitable for the lack of muscle strength and coordination in the tongue after stroke. Chinese medicine as the treasure of traditional Chinese medicine, the traditional Chinese medicine ice popsicle pharynx stimulation in the rehabilitation treatment of dysphagia also showed a unique effect. Through clinical treatment and observation, the combined treatment group and the single treatment group, the control group have significant differences, the combined treatment group is better than the single treatment group and the control group. It is hoped that this study can provide a new concept of swallowing rehabilitation for clinical treatment, promote the development of rehabilitation therapy for dysphagia, and benefit more patients with dysphagia. Objective: to investigate the therapeutic effect of tongue pressure resistance feedback training combined with Chinese traditional Chinese medicine ice popsicle pharynx stimulation on dysphagia after cerebral infarction. Methods: 120 patients with dysphagia after cerebral infarction were randomly divided into 3 groups, 40 cases in each group. The general treatment group was the control group, which was given routine swallowing rehabilitation training treatment; the treatment group A was treated with traditional Chinese medicine ice-stick pharynx stimulation in addition to the routine swallowing rehabilitation training treatment; and the treatment group B was treated with combined treatment group. Group A was treated with tongue pressure resistance feedback training, and the clinical effects of three groups were compared. Results: all the three treatment groups could improve the dysphagia, but the curative effect of the combined treatment group was better than that of the other groups (P0.05). Conclusion: the treatment of dysphagia after cerebral infarction by tongue pressure resistance feedback training combined with traditional Chinese medicine ice popsicle pharynx stimulation can shorten the treatment time and improve the swallowing function effectively. The combined therapy is better than the single rehabilitation therapy.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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