Study On The Effect Of Swallowing Training Combined With Pulmonary Rehabilitation On Rehabilitation And Extubation Rate Of Elderly Stroke Patients With Tracheotomy

Objective Apply the method of swallowing training combined with pulmonary rehabilitation to the elderly stroke patients with tracheotomy and explore the effect of the combined training on the success rate of tracheal extubation and the rehabilitation efficacy of the patients including swallowing function,pulmonary function and the severity of lung infection.Methods A total of 50 elderly stroke patients with tracheotomy who were hospitalized in the Department of Rehabilitation Medicine Ward and Respiratory support ward of North Campus of Hangzhou First People’s Hospital from January to March 2023 were prospectively collected.They were randomly divided into the combined training group and the pulmonary rehabilitation group with 25 patients each according to the random number table method.The pulmonary rehabilitation group only received pulmonary rehabilitation training,while the combined training group increased swallowing training on the basis of the pulmonary rehabilitation group.The treatment methods of pulmonary rehabilitation include ①body position management,muscle relaxation,②airway clearance technology,③position drainage,vibration sputum drainage,④oscillatory positive expiratory pressure,⑤respiratory gymnastics,⑥external diaphragm pacing training;The swallowing training methods include①basic swallowing training,②airway protection training,③speech valve wearing training,④direct feeding training,⑤neuromuscular low-frequency electrical stimulation.Both groups were treated once a day,five times a week,for four weeks.After 4 weeks of treatment,compare the changes of Rosenbek leakage and aspiration scale(PAS)which was evaluated by swallowing fiber optic endoscopy evaluation of swallowing(FEES),pulmonary function indexes which was detected by portable pulmonary function detector including forced vital capacity(FVC),forced expiratory volume in 1s(FEV1),the percentage of forced expiratory volume in 1 second%prediction(FEV1%),peak expiratory flow(PEF),respiratory muscle strength:maximum inspiratory pressure(MIP)and maximum expiratory pressure(MEP),as well as the change of the degree of pulmonary infection(CPIS)and the success rate of extubation.Result1.There was no significant difference in basic data analysis between the combined training group and the pulmonary rehabilitation group,and the two groups were comparable(p>0.05);2.Comparison of swallowing function between the two groups:the PAS grade of the combined training group was significantly lower than that of the pulmonary rehabilitation group after treatment(2.00(1.00,4.00)vs 4.00(2.00,5.00)),and the difference was statistically significant(p<0.05);3.After treatment,the lung function indexes of the two groups were compared:FVC:There was statistically significant difference between the combined training group and the pulmonary rehabilitation group(1.71(1.05,1.90)vs 1.13(1.00,1.74))(p<0.05);FEV1%:there was no significant difference between the combined training group and the pulmonary rehabilitation group(79.00(76.00,83.75)vs 77.00(73.00,83.75))(p>0.05);FEV1:there was no significant difference between the combined training group and the pulmonary rehabilitation group(1.39(0.80,1.60)vs 0.86(0.76,1.47))(p>0.05);PEF:There was statistically significant difference between the combined training group and the pulmonary rehabilitation group(1.90(1.21,2.13)vs 1.26(1.10,1.80))(p<0.05);MIP:There was a statistically significant difference between the combined training group and the pulmonary rehabilitation group(25.0(15.50,28.75)vs 17.5(15.00,25.00))(p<0.05);MEP:The difference between the combined training group and the pulmonary rehabilitation group(34.00(25.25,37.00)vs 24.50(22.00,34.00)was statistically significant(p<0.05);4.Comparison of the CPIS score of lung infection severity between the two groups:the lung infection severity of the combined training group was significantly lighter than that of the pulmonary rehabilitation group(0.00(0.00,2.00)vs 2.00(0.00,3.00)),and the difference was statistically significant(p<0.05);5.After treatment,the success rate of tracheal cannula extubation in the combined training group was significantly higher than that in the pulmonary rehabilitation group(63.5%vs 33.5%),the difference was statistically significant(p<0.05).Conclusion Swallowing training combined with pulmonary rehabilitation can improve the safety of swallowing and reduce the occurrence of aspiration.It can also improve the respiratory muscle strength and enhance the cough capacity of elderly stroke patients with tracheotomy so that they can remove respiratory secretions more effectively.Furthermore,it can reduce the severity of lung infection,and improve the pulmonary ventilation and the success rate of extubation in the elderly stroke patients with tracheotomy.