《中国康复理论与实践》

《中国康复理论与实践》 ›› 2013, Vol. 19 ›› Issue (12): 1167-1170.

• 论文 • 上一篇    下一篇

心理康复对脑卒中吞咽障碍并发认知和心理障碍患者的疗效

崔燕，元小冬，王淑娟，吴宗武，孟令民   

  1. 开滦总医院神经内科，河北唐山市063000。
  • 收稿日期:2012-12-31 修回日期:2013-04-04 出版日期:2013-12-25 发布日期:2013-12-25
  • 通讯作者: 元小冬

Psychological Rehabilitation on Dysphagia with Cognitive and Psychological Disorders post Stroke

CUI Yan, YUAN Xiao- dong,WANG Shu-juan, et al.   

  1. Kailuan General Hospital, Tangshan 063000, Hebei, China
  • Received:2012-12-31 Revised:2013-04-04 Published:2013-12-25 Online:2013-12-25

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摘要： 目的探讨综合康复对脑卒中吞咽障碍并发认知和心理障碍患者的效果。方法120 例脑卒中吞咽功能障碍并发认知和心理障碍患者分为实验组(n=60)和对照组(n=60)。两组入院后均进行神经内科常规治疗以及吞咽功能康复训练、摄食训练和低频电刺激等治疗；实验组在此基础上再进行认知功能和心理治疗。治疗前和治疗1 个月后分别应用洼田饮水试验、简易精神状态检查(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评定。结果治疗1 个月后，两组吞咽功能均显著改善(P<0.001)，且实验组显著优于对照组(P<0.001)。实验组总有效率90%，对照组总有效率73.3%，实验组明显优于对照组(P<0.01)。实验组MMSE评分显著提高(P<0.001)，且显著高于对照组(P<0.001)。而对照组评分改变无统计学意义(P>0.05)。实验组HAMD评分和HAMA评分显著降低(P<0.001)，且显著低于对照组(P<0.001)，而对照组仅HAMA评分降低(P<0.05)。结论在吞咽功能康复训练的同时对脑卒中吞咽障碍并发认知和心理障碍患者给予认知和心理治疗，不仅能改善认知功能和心理状态，还有利于吞咽功能的恢复。

关键词: 脑卒中, 吞咽障碍, 认知障碍, 心理障碍

Abstract: Objective To explore the clinical effect of psychological rehabilitation on dysphagia with cognitive and psychological disorders post stroke. Methods 120 stroke patients with dysphagia complicated with cognitive and psychological disorders were divided into experimental group (n=60) and control group (n=60). Both groups received neurological routine medical treatment, swallowing function rehabilitation training, feeding training and low-frequency electrical stimulation. Cognitive and psychological therapy was additionally used in the experimental group. Both groups were assessed by Kubota DrinkingWater Test, Mini-Mental State Examination (MMSE), Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA). Results 1 month after intervention, the score of Kubota Drinking Water Test improved significantly in both groups, and was higher in the experimental group than in the control group (P<0.001).The rate of clinical improvement was higher in the experimental group than in the control group (P<0.01). The scores of MMSE increased significantly in the experimental group (P<0.001). The scores of HAMD and HAMA decreased significantly in the experimental group (P<0.01). Only the scores of HAMA decreased in the control group (P<0.05). Conclusion Swallowing function rehabilitation training combined with cognitive and psychological therapy may facilitate to improve the cognitive function and psychological state and swallowing function for dysphagia with cognitive and psychological disorders post stroke.

Key words: stroke, dysphagia, cognitive impairment, psychological disorder