A Primary Study On Patients With Dysphagia After Actue Stroke

PartⅠA clinical study of neuromuscular electrical stimulation on patients with dysphagia after actue strokeBackground Dysphagia is a common complication as well as an independent risk factor of poor prognosis in patients with actue stroke, Though the neuromuscular electrical stimulation (NMES) is promising, It was limited in clinical application due to disputed effects.Objective To observe the effects of NMES on patients with dysphagia after actue stroke (DAS) and explore the probable mechanisms of the treatment. Methods In a prospective, randomized, controlled design. 129 patients with acute stroke were enrolled in this study. Their wallowing function were evulated within admission 48 hours. 60 patients with DAS diagnosed by videofluoroscophic swallowing study(VFSS) were divided into two groups randomly, a treatment group(n=30) and a control group (n=30). Both groups received routine internal medicine treatment and conventional rehabilitation treatment. The treatment group was also treated with NMES simultaneously for 10 days. VFSS, aspiration, throat elevation, food residues and food intake scores of two groups were evulated and compared before and after 10 days of treatment. The curative effects were evulated and compared using Wa Tian drinking water test scale after treatment 10 days,1 month and 6 months.Results There were no significant difference between the two groups with regard to age,gender, course of disease, treatment times, VFSS score and aspiration, throat elevation, food residues, food intake scores before treatment (p>0.05). At the 10th day of treatment, VFSS of treatment group was higher than those of control group, aspiration, throat elevation score in treatment group were lower than those of control group (p<0.05). the effective rate and the significant effective rate of two groups were significant difference (p<0.05). Food residues and food intake scores of two groups were no significant difference (p>0.05). 1 month after treatment, effective rate in two groups were no significant difference (p>0.05), but the significant effective rate of treatment group was remarkably higher than that of the control group (p<0.05). 6 months after treatment, the prognosis of two groups was no difference (p>0.05).Conclusion The efficacy of NMES on DAS was affirmative at 10 days and 1month after treatment. The probable mechanisms of NMES on DAS were to improve the throat elevation and aspiration level.PartⅡAnalysis of the related factors influencing dysphagia severity following actue strokeObjective To investigate the related factors influencing severity after actue stroke(DAS) in order to provide effective methods for management of DAS.Methods 60 DAS patients diagnosed by videofluoroscophic swallowing study (VFSS) were enrolled in this study. Their wallowing function were evulated within admission 48 hours by VFSS.The correlations between the VFSS scores and the related factors such as the age, sex, the previous positive/negative diabetes, strok history, whether a the brain-stem or cerebellum strok, strok size, single or multiple strok lesion, high- sensitivity C-reactive protein(CRP), blood glucose, low-density lipoprotein (LDL), blood plasma fibrinogen density (Fib), NIH Stroke Scale(NIHSS)Score and Barthel index(BI) were analyzed by univariate analysis and multiple stepwise regression analysis.Results Univariate analysis showed that VFSS scores were associated with the previous positive/negative stroke history, strok size, age, CRP, NIHSS score, BI and Fib (p<0.05). Multiple stepwise regression analysis revealed that VFSS score was negatively correlated with age and Fib, while positively correlated with BI(p<0.05). The standardization partial regression coefficient were -0.194, -0.223 and 0.553, respectively.Conclusion Information gathered at admission from patients with DAS can help predict dysphagia severity.BI, Fib, age were independently correlated with DAS. PartⅢAnalysis of the related factors influencing dysphagia prognosis after actue strokeObjective To explore factors influencing dysphagia prognosis after actue stroke in order to provide effective methods for management of dysphagia after actue stroke (DAS).Methods 60 DAS patients were enrolled in this study. The admission datas of 60 DAS patients were registered such as the age, sex, the previous positive/negative diabetes, strok history, whether a the brain-stem or cerebellum stroke, stroke size, single or multiple stroke lesion, high-sensitivity C-reactive protein(CRP), blood glucose, low-density lipoprotein (LDL), blood plasma fibrinogen density (Fib), NIH Stroke Scale(NIHSS)Score and Barthel index(BI). After 6 month,The patients were divided into two groups which poor prognosis and well prognosis by Wa Tian drinking water test scale.The correlations between the DAS prognosis and the thirteen factors were analyzed by univariate analysis and multiple logistic regression analysis.Results Univariate analysis showed that age, Stroke size, BI, NIHSS score were related with the DAS prognosis (p<0.05), Multiple logisticre regression analysis revealed that age≥70 and BI≤30 were intimately related with DAS prognosis (p<0.05).Conclusion Datas gathered at admission from patients with DAS can help predict the prognosis of the patients.age≥70 and BI≤30 were independently risk factors of poor prognosis with DAS.