發(fā)布時(shí)間：2018-04-19 10:14

  本文選題：吞咽障礙 + 吞咽姿勢�。� 參考：《鄭州大學(xué)》2013年碩士論文

【摘要】：目的：吞咽障礙是腦卒中后的常見并發(fā)癥之一,據(jù)報(bào)道,其發(fā)生率約占30%-65%,顱腦損傷造成吞咽障礙高達(dá)61%-93%�？稍斐墒澄餁埩�、嗆咳、誤咽、氣道梗阻、反復(fù)吸入性肺炎、營養(yǎng)不良和脫水等并發(fā)癥,甚至窒息危及生命,嚴(yán)重影響患者的康復(fù)療效和生活質(zhì)量。本文通過電視透視吞咽造影,觀察不同體位和頭部姿勢改變對(duì)腦卒中后吞咽障礙患者的影響,以及其對(duì)會(huì)厭谷和梨狀竇殘留物的清理作用。 方法：選擇2011年9月至2012年8月本院收治的69例經(jīng)電視透視吞咽檢查(VFSS)顯示存在吞咽障礙和殘留的腦卒中患者,在X線下觀察患者分別在30°、60°、90°仰臥位時(shí),不同的體位對(duì)患者口腔期和咽期吞咽的影響,以及仰頭吞咽和頭旋轉(zhuǎn)吞咽對(duì)會(huì)厭谷和梨狀竇殘留物的清理作用。選擇誤吸最明顯的體位囑患者低頭吞咽,觀察低頭吞咽是否可以減少或防止誤吸。將69例患者隨機(jī)分為觀察組和治療組,治療組進(jìn)行常規(guī)吞咽訓(xùn)練,觀察組選擇在30°仰臥位進(jìn)行吞咽功能訓(xùn)練,在60°仰臥位進(jìn)行仰頭吞咽和頭旋轉(zhuǎn)吞咽清除會(huì)厭谷和梨狀竇殘留,在直接訓(xùn)練時(shí)采取低頭吞咽,在治療1個(gè)月后再次進(jìn)行飲水實(shí)驗(yàn)和VFSS檢查。 結(jié)果：本研究結(jié)果顯示,在30°、60°、90°仰臥位三種體位中,在90°仰臥位時(shí)會(huì)厭谷殘留最明顯,在30°、60°仰臥位時(shí)殘留減少,梨狀竇殘留在三種體位無明顯區(qū)別。在60°仰臥位時(shí),頭旋轉(zhuǎn)吞咽和仰頭吞咽清理殘留物更加有效,而且清除梨狀竇和會(huì)厭谷殘留物容積也最多。60°仰臥位時(shí)碘劑通過口咽時(shí)間較短。30°仰臥位時(shí)防止誤咽效果最好。90°仰臥位時(shí)誤吸最明顯,在此位置囑患者低頭吞咽可有效防止誤吸。兩組患者治療前洼田氏飲水實(shí)驗(yàn)分級(jí)及VFSS檢查結(jié)果比較,組間差異均無統(tǒng)計(jì)學(xué)意義(P0.05),經(jīng)過一個(gè)月治療后,兩組患者吞咽功能均較治療前明顯提高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),而且觀察組提高較治療組明顯,組問比較差異亦具有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：吞咽姿勢改變是讓患者的頭部或身體改變某種姿勢即可解除吞咽障礙的癥狀,而且可改善或消除吞咽時(shí)的誤吸癥狀。此方法能保持患者的正常生理功能,提高吞咽的安全性,根據(jù)電視透視吞咽造影(VFSS)檢查結(jié)果選擇在30°仰臥位進(jìn)行吞咽功能訓(xùn)練,在60°仰臥位清除會(huì)厭谷和梨狀竇殘留,在直接訓(xùn)練時(shí)采取低頭吞咽,臨床研究顯示,應(yīng)用此方法,可明顯提高患者吞咽功能,治療效果優(yōu)于常規(guī)吞咽訓(xùn)練,明顯減少吸入性肺炎的發(fā)生,提高了患者生存率和生活質(zhì)量。
[Abstract]:Objective: dysphagia is one of the common complications after stroke. It is reported that the incidence of dysphagia is about 30%-65, and the swallowing disorder caused by craniocerebral injury is as high as 61-933.It can cause food residue, cough, false pharynx, airway obstruction, repeated aspiration pneumonia, malnutrition, dehydration and other complications, even suffocation endangers life, seriously affecting the rehabilitation effect and quality of life of patients.The effects of different postural and head posture changes on patients with dysphagia after stroke and their cleaning effects on the residues of epiglottic valley and piriform sinus were observed by means of television fluoroscopy.Methods: from September 2011 to August 2012, 69 patients with stroke who had dysphagia and residual cerebral apoplexy were examined by VFSS. The patients were observed in the supine position of 30 擄(60 擄) and 90 擄(90 擄) under X-ray, respectively.The effects of different postures on oral and pharyngeal swallowing, as well as on the removal of residual residues of epiglottic valley and piriform sinus by scalp swallowing and head rotation swallowing.Choose the most obvious body position to ask the patient to swallow down and see if the swallowing can reduce or prevent accidental aspiration.69 patients were randomly divided into observation group and treatment group. Routine swallowing training was performed in the treatment group, swallowing function training was performed in 30 擄supine position, supine swallowing and head rotation swallowing were performed in 60 擄supine position to remove residual of epiglottic valley and piriform sinus.After one month of treatment, drinking water test and VFSS examination were performed again.Results: the results showed that in the supine position of 30 擄and 60 擄and 90 擄, the residual of the epiglottic valley was the most obvious in the supine position of 90 擄, decreased in the supine position of 30 擄and 60 擄, and remained in the Pyriform sinus in the three postures.At 60 擄supine position, head rotated swallowing and supine swallowing are more effective in cleaning up residue,Moreover, when removing the residue volume of piriform sinus and epiglottic valley at the maximum of .60 擄supine position, the effect of iodine on the oral pharynx time was shorter. 30 擄supine position was the most effective in preventing mispharyngeal aspiration. In this position, it was the best to prevent mispharyngeal aspiration in the supine position of .90 擄. In this position, ordering the patient to lower his head and swallow can effectively prevent misabsorption.After one month of treatment, the swallowing function of the two groups was significantly improved, compared with the results of Wada's drinking water test and VFSS examination, no significant difference was found between the two groups after one month of treatment, and there was no significant difference between the two groups after one month of treatment, the swallowing function of the two groups was significantly higher than that of the control group.The difference was statistically significant (P 0.05), and the improvement in the observation group was significantly higher than that in the treatment group, and the difference between the two groups was statistically significant (P 0.05).Conclusion: swallowing posture change can relieve the symptoms of dysphagia, and can improve or eliminate the symptoms of swallowing.This method can maintain the normal physiological function of the patients and improve the safety of swallowing. According to the results of TV fluoroscopic swallowing angiography (VFSS), the patients were given swallowing function training in 30 擄supine position and 60 擄supine position to clear the residual of epiglottic Valley and Pyriform sinus.The clinical research shows that this method can obviously improve the swallowing function of the patients, and the therapeutic effect is better than that of the routine swallowing training, and the incidence of aspiration pneumonia is obviously reduced.The survival rate and quality of life were improved.
【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】：2013
【分類號(hào)】：R493;R816

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