Post-stroke dysphagia: novel treatment approaches
Post-stroke dysphagia: novel treatment approaches
复制标题
中风后吞咽困难：新的治疗方法
DOI：
10.14412/2074-2711-2018-2-57-62
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
O. Lagoda
中科院分区：
文献类型：
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作者：
M. Tanashyan;E. Berdnikovich;O. Lagoda
本文介绍缺血性脑卒中恢复期早期患者的检查和治疗结果。它考虑了药物和语言治疗的同时使用，以改善卒中后语言和吞咽障碍患者的康复。目的：探讨语言疗法和神经心理学在缺血性脑卒中恢复期言语和吞咽障碍治疗中的作用。患者和方法。共有45例患者（男性32例（71%），女性13例（29%））患有2 - 3个月的缺血性脑卒中病史。随访2个月。患者分为两组。第一组（一个研究小组）包括30名接受联合治疗的患者（药物治疗；语言病理学家疗程；以及恢复吞咽功能的补偿性治疗）。所有患者均有中度吞咽困难并伴有语言障碍。中度感觉运动失语症15例；15例患者出现中度构音障碍。长春西汀（Cavinton®）及其分散片（Cavinton®Comfort）被选为血管活性治疗的药物。第二组（对照组）由15例吞咽困难患者组成，他们只接受标准治疗和语言治疗。感觉运动失语症2例（4%），构音障碍13例（29%）。采用Mann吞咽能力评估（MASA）、构音障碍评估和L.I. Vasserman设计的评估局部脑损伤患者语言障碍程度的量表进行复杂的心理和语音学检查。结果和讨论。45例患者治疗后吞咽功能均有改善；而第1组患者的阳性变化更为明显（p< 0.05）。调查数据、可能的饮食改变、更好的患者沟通、患者生活质量的改善以及患者亲属和医务人员的意见作为评估模型用于恢复吞咽功能有效性的标准。主观改善表现为25例（56%）患者初始化咽部吞咽的能力增强，10例（22%）患者在口腔内食物丸的运动没有轻微延迟（长达5秒），10例（22%）患者在摄入不同稠度的食物时没有延迟。第1组在一个治疗周期后，出现轻度吞咽困难的患者数量增加了30%；63%的患者存在中度吞咽障碍，这需要继续进行药物和言语矫正。有中度皮质和皮质-皮质下病变的第1组患者中，有10%的患者吞咽功能显著改善；67%的中小脑灶患者在同一部位出现中度改善。与此同时，第2组只有20%的患者出现不显著的阳性变化，其中大部分患者存在构音障碍。结论。脑卒中后的高发病率使得在一系列多学科专业类型的护理中使用语言治疗方法是合理的。这种护理应该是个性化的；在这种情况下，处方易于吞咽的分散药物起着重要作用。这将提高患者的生活质量，并保护他免受不必要的并发症。
The paper presents the results of examination and treatment in patients in the early recovery period of ischemic stroke. It considers the concurrent use of drug and speech therapies to improve the rehabilitation of patients with post-stroke speech and swallowing disorders. Objective : to identify the role of speech-language therapy and neuropsychology sessions in the treatment of speech and swallowing disorders in the early recovery period of ischemic hemispheric stroke. Patients and methods . A total of 45 patients (32 (71%) men and 13 (29%) women) with a 2–3-month history of ischemic hemispheric stroke were examined. The follow-up period was 2 months. The patients were divided in two groups. Group 1 (a study group) included 30 patients who received combination therapy (drug treatment; sessions with a speech-language pathologist; and compensatory treatments for restoring swallowing function). All the patients had moderate dysphagia accompanied by speech disorders. Moderate sensorimotor aphasia was observed in 15 patients; moderate dysarthria was also seen in 15 patients. Vinpocetine (Cavinton®) and its dispersible tablets (Cavinton® Comfort) were chosen as an agent for vasoactive therapy. Group 2 (a comparison group) consisted of 15 patients with dysphagia who had only standard therapy and speech therapy sessions. There was sensorimotor aphasia in 2 (4%) patients and dysarthria in 13 (29%). A complex psychological and logopedic examination was carried out using the Mann Assessment of Swallowing Ability (MASA), dysarthria assessment, and the scale designed by L.I. Vasserman for estimating the degree of speech disorders in patients with local brain injuries. Results and discussion . Posttreatment swallowing function improved in all the 45 patients; however, more pronounced positive changes were recorded in the patients of Group 1 (p< 0.05). Survey data, possible diet modification, better patient communications, improved quality of life in the patients, and the opinions of their relatives and medical staff served as criteria for the effectiveness of the model used to recover swallowing function. A subjective improvement showed itself as an increased ability to initialize the pharyngeal phase of swallowing in 25 (56%) patients and none mild delays (up to 5 sec) in the movement of a food bolus in the oral cavity in 10 (22%) patients and in the intake of the food of different consistency in 10 (22%). After a treatment cycle in Group 1, the number of patients with mild dysphagia increased up to 30%; moderate swallowing disorders were present in 63% of patients, which required that medical and speech correction should be continued. A significant improvement in swallowing function was noted in 10% of Group 1 patients with medium-sized cortical and cortical-subcortical lesions; a moderate improvement was seen in 67% with medium and small cerebral foci at the same location. At the same time, in Group 2 there were insignificant positive changes only in 20% of patients, most of whom had dysarthria. Conclusion. The high incidence of post-stroke makes it reasonable to use speech therapy methods in a set of multidisciplinary specialized types of care. This care should be personalized; prescribing easy-to-swallow dispersible drugs plays an important role in this case. This will improve quality of life in the patient and protect him from unwanted complications.