| Background:Dysphagia that is a common complication after cerebral infarction, may be the only or prominent symptom in some patients.The complications that dysphagia can bring about aspiration, pneumonia, malnutrition and electrolyte disturbance, will result from decreasing quality of life and increasing mortality. Because the existing of neuronal plasticity, the majority of dysphagia after cerebral infarction may recover by itself, but dysphagia will ultimately affect the prognosis of patients.Hower, it is very important for patients to save in defining the patient's swallow ability and managing the resulting dysphagia.PARTI Value of The Combination of Water Swallow Test and Oxygen Desaturation Monitoring in Assessing Aspiration after Cerebral InfarctionObjective:To explore the value of the combination of water swallow test and oxygen desaturation monitoring in assessing aspiration after acute cerebral infarction. To compare videofluoroscopic swallowing study (VFSS), we study the value of this test in screening for aspiration after cerebral infarction, for developing a valid and valuable assessing tool.Methods:One hundred acute cerebral infarction patients underwent an examination of their ability to swallow 30 ml of water, the oxygen desaturation test and VFSS. The water swallow test, the oxygen desaturation test and the combination of both (termed "clinical combination test") was then measured against the VFSS for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for aspiration in acute cerebral infarction patients. The relation between the results of three assessment tools and pneumonia of post-stroke were analyzed.Results:The water swallow test had a sensitivity of 65.2%and specificity of 72.2% for the detection of aspiration, with PPV of 66.7%and NPV of 70.2%. The oxygen desaturation test had a sensitivity of 80.4%and a specificity of 75.9%, with PPV of 74.0%and NPV of 82.0%. When both tests were combined, a sensitivity of 93.5%and a specificity of 68.5%was attained, with PPV of 71.6%and NPV of 92.5%. The patients with positive result on clinical combination test had a higher incidence of pneumonia(P <0.05), but there were no significant difference in other two groups.Conclusions:The combination of water swallow test and oxygen desaturation monitoring is a valid and valuable assessing tool for dysphagia in acute cerebral infarction patients.PART II Therapeutic Effects of Early Rehabilitation Training Combined with Acupuncture for Dysphagia after Acute Cerebral InfarctionObjective:To study the clinical therapeutic effects of early rehabilitation training combined with acupuncture on dysphagia after acute cerebral infarction. The clinic research that this topic draws up to further clear the impact of different treatment measures of swallow function, malnutrition indicators of nutrition and complications, suffer a stroke to swallow difficulty treatment result with the exaltation, shorten to cure time, reduce the complications, improve the quality of life in patients.Methods:One hundred patients with dysphagia caused by acute cerebral infarction were randomly divided into 4 groups:a comprehensive treatment group (25 cases, received rehabilitation training, acupuncture and routine mediciation), a routine drug group (25 cases, routine mediciation), a rehabilitation group (25 cases, received comprehensive rehabilitation training and routine mediciation) and an acupuncture group (25 cases, received acupuncture therapy and routine mediciation). Dysphagia was evaluated by VFSS, and the incidence of pneumonia, Albumin (Alb), hemoglobin (Hb), and total lymphocyte count (TLC) were observed before treatment and at the 14st day after treatment.Results:After treatment, the VFSS scores of 4 groups were significantly higher than those before treatment (P<0.05), and VFSS scores in the comprehensive treatment group were higher than those in the other groups(P<0.05).The effectiveness rate in the comprehensive treatment group was higher than that in the other three groups(P<0.05), and the incidence of pneumonia was significantly lower (P<0.05). The TLC and the level of Hb, Alb in the the comprehensive treatment group were higher than in other groups(P<0.05).Conclusions:Early rehabilitation training combined with acupuncture can improve swallowing, reduce the incidence of pneumonia and alleviate the deteriorating malnutrition in acute stroke patients.
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