摘要
目的 探讨神经肌肉电刺激(NMES)联合容积-黏度吞咽测试(V-VST)饮食营养指导对脑卒中后吞咽障碍(PSD)患者营养状态、吞咽相关性肺炎(SAP)发生率及生活质量的影响。方法 前瞻性纳入2019年1月至2024年12月于成都市第六人民医院神经内科收治的90例PSD患者,按照随机数字表法将其分为对照组(n=45)和研究组(n=45)。对照组采用常规吞咽训练,研究组采用常规吞咽训练+V-VST+NMES。比较两组治疗前、治疗1个月后的营养指标(血红蛋白、白蛋白、总蛋白、葡萄糖)、吞咽功能(Murry分泌物严重程度分级、渗透-误吸量表评分、标准吞咽量表评分)、吞咽障碍特异性生活质量量表(SWALQOL)生活质量评分(社会交往、睡眠、疲劳、心理健康、语言交流、恐惧、心理负担、症状频率、进食时间、食物选择、食欲),并记录两组不良事件SAP发生率。结果 治疗1个月后,两组的血红蛋白、白蛋白、总蛋白较治疗前均升高,葡萄糖水平较治疗前均降低,且研究组的血红蛋白、白蛋白、总蛋白分别为(111.36±2.11)、(49.16±5.87)、(70.44±7.56) g/L,均高于对照组[(98.66±2.06)、(37.44±5.22)、(63.16±7.11)g/L],葡萄糖水平为(5.33±0.45) mmol/L,低于对照组[(5.87±0.51) mmol/L],差异均有统计学意义(P<0.05)。治疗1个月后,两组患者Murry分泌物严重程度分级、渗透-误吸量表评分、标准吞咽量表评分较治疗前均降低,且研究组各指标分别为(0.92±0.23)级、(2.56±1.02)分、(22.08±3.66)分,均低于对照组[(1.12±0.22)级、(3.12±1.11)分、(26.45±4.65)分],差异均有统计学意义(P<0.05)。治疗1个月后,两组各维度评分社会交往、睡眠、疲劳、心理健康、语言交流、恐惧、心理负担、症状频率、进食时间、食物选择、食欲较治疗前均升高,且研究组各维度评分均高于对照组,差异均有统计学意义(P<0.05)。研究组误吸及SAP发生率分别为4.44%、6.67%,均低于对照组(17.78%、24.44%),差异均有统计学意义(P<0.05)。结论 NMES联合V-VST饮食营养指导可改善PSD患者的营养状态,提高生活质量,降低SAP及误吸风险,值得临床推广。
Objective To investigate the effects of neuromuscular electrical stimulation(NMES)combined with volume-viscosity swallow test(V-VST)diet and nutrition guidance on nutritional status,the incidence of swallowing-associated pneumonia(SAP),and quality of life in poststroke dysphagia(PSD)patients.Methods A total of 90 patients with PSD admitted to the Department of Neurology,Chengdu Sixth People's Hospital from January 2019 to December 2024 were prospectively included and divided into the control group(n=45)and the study group(n=45)according to the random number table method.The control group received conventional swallowing training,and the study group received conventional swallowing training+V-VST+NMES.The nutritional indicators(hemoglobin,albumin,total protein,glucose),swallowing function(Murry secretion severity classification,penetration-mistake scale score,standard swallowing scale score),swallowing quality of life questionnaire(SWALQOL)score(social interaction,sleep,fatigue,mental health,language communication,fear,psychological burden,symptom frequency,eating time,food selection,appetite)were compared between the two groups before treatment and 1 month after treatment,the advers events and the incidence of SAP and aspiration were recorded in the two groups.Results After 1 month of treatment,the levels of hemoglobin,albumin and total protein in the two groups were higher than those before treatment,and the levels of glucose were lower than those before treatment,the levels of hemoglobin,albumin and total protein in the study group were(111.36±2.11),(49.16±5.87)and(70.44±7.56)g/L,respectively,which were higher than those in the control group[(98.66±2.06),(37.44±5.22)and(63.16±7.11)g/L],and the level of glucose in the study group was(5.33±0.45)mmol/L,which was lower than that of the control group[(5.87±0.51)mmol/L],and the difference was statistically significant(P<0.05).After 1 month of treatment,the Murry secretion severity grading,penetration-misabsorption scale score and standard swallowing scale score of the two groups were lower than those before treatment,and the indexes of the study group were(0.92±0.23)levels,(2.56±1.02)pionts and(22.08±3.66)pionts,respectively,which were lower than those of the control group[(1.12±0.22)levels,(3.12±1.11)pionts and(26.45±4.65)pionts],the differences were statistically significant(P<0.05).After 1 month of treatment,the scores of social interaction,sleep,fatigue,mental health,language communication,fear,psychological burden,symptom frequency,eating time,food selection and appetite in the two groups were higher than those before treatment,and the scores of each dimension in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidences of aspiration and SAP in the study group were 4.44%and 6.67%,respectively,which were lower than those in the control group(17.78%,24.44%),and the differences were statistically significant(P<0.05).Conclusion NMES combined with V-VST dietary nutrition guidance can improve the nutritional status and quality of life of PSD,reduce the risk of SAP and aspiration,and is worthy of clinical promotion.
作者
曾滢
刘先红
郭忠艳
ZENG Ying;LIU Xianhong;GUO Zhongyan(Department of Neurology,Chengdu Sixth People's Hospital,Chengdu Sichuan 610051,China)
出处
《临床和实验医学杂志》
2026年第3期238-242,共5页
Journal of Clinical and Experimental Medicine
基金
四川省科技计划项目(编号:2022ZHY20015)
2021年成都市医学科研课题(编号:2021417)。
关键词
脑卒中
吞咽障碍
神经肌肉电刺激
容积-黏度吞咽测试
营养状态
生活质量
Stroke
Deglution disorders
Neuromuscular electrical stimulation
Volume-viscosity swallow test
Nutritional status
Quality of life
