Effect Of Liuzijue On Dysphagia In Ischemic Stroke Patients With Phlegm And Blood Stasis Blocking Collaterals

ObjectiveThis study applied Liuzijue to the rehabilitation care of phlegm-blood stasis blocking type ischemic stroke patients with dysphagia and investigated the effect of the Liuzijue on patients’swallowing function,respiratory function and quality of life,aiming to provide a simple,safe and effective rehabilitation training method for stroke swallowing disorder for clinical,community and family use.MethodsAccording to the principle of convenient sampling and the inclusion and exclusion criteria,84 phlegm-stasis blocking type Ischemic stroke patients with dysphagia,who were admitted to the Department of Neurology,Fuzhou Second Hospital from December 2019 to June 2021,were selected and divided into control group and experimental group using random number table.The control group was treated with conventional therapy,routine nursing and rehabilitation nursing.The experimental group added Liuzijue training to the conventional treatment and practiced once a day（30 min）for 12 weeks.Both groups were evaluated before and after the 12 weeks intervention by（1）assessing swallowing function by the Eating Assessment Questionnaire（EAT-10）as well as the Water Swallow Test;（2）assessing patients’phlegm-stasis evidence score using the Chinese medicine symptom grading quantification scale for stroke disease（phlegm-stasis obstruction evidence）;（3）measuring patients’exertional spirometry using a pulmonary function meter(Forced Vital Capacity（FVC）,Forced Expiratory Volume In First Second（FEV₁）and Maximal Voluntary Ventilation Per Minute（MVV）,to assess the patient’s respiratory function;（4）the Swallowing Quality of Life（SWAL-QOL）was used to assess patients’quality of life.Results1.Study conducted:a total of 84 patients with phlegm-stasis blocking ischemic stroke swallowing disorder who met the criteria were included in this study.During the intervention period,3 cases fell off in the test group and 2 cases fell off in the control group.A total of 79patients,39 in the test group and 40 in the control group,finally completed the study and were included in the data analysis.2.Baseline comparison:there were no statistical differences（P>0.05）between the two groups in terms of gender,age,body mass index,marriage,education,smoking status,duration of illness（days）before admission,and whether a gastric tube was placed;Before the trial,EAT-10 score,Water swallow test scale,phlegm-stasis obstruction evidence score of stroke disease,Pulmonary function（FVC,FEV₁ and MVV）and the Swallowing Quality of Life Scale（SWAL-QOL）were not statistically different between groups（P>0.05）.The two groups of patients were comparable.3.Swallowing Function:（1）Eating Assessment Questionnaire（EAT-10）.After the intervention,the EAT-10 scores of patients in both the test and control groups improved significantly compared with those before the intervention（P<0.05）,the test group had more significant improvement of EAT-10 scores than the control group after the intervention（P<0.05）.（2）Water Swallow Test（WST）.The grade of WST in both groups significantly decreased after the intervention compared with the pre-intervention period（P<0.05）.After the intervention,36 patients in the test group had significant effect,2 patients had effective effect,and 1 patient had ineffective effect,and the total effective rate was 97.43%;28 patients in the control group had significant effect,9 patients had effective effect,and 3 patients had ineffective effect,and the total effective rate was 92.5%,and the difference between the two groups was statistically significant（P<0.05）.4.Phlegm-stasis blocking evidence points:compared within the group before and after the intervention,the phlegm-stasis blocking evidence points of stroke disease in both groups showed significant improvement compared with those before the intervention（P<0.05）.When comparing between groups after intervention,patients in the test group had more significant improvement in the points of phlegm-stasis blocking evidence of stroke disease than those in the control group,and the difference was statistically significant（P<0.05）.5.Pulmonary function:compared within the group before and after the intervention,the FVC,FEVl and MVV of patients in the test group improved compared with those before the intervention,and the improvement degree was statistically significant（P<0.05）;the FVC,FEVl and MVV of patients in the control group slightly improved compared with those before the intervention,but there was no statistical significance.When comparing between groups after intervention,patients in the test group had higher FVC,FEVl,and MVV values than the control group,with statistically significant（P<0.05）.6.Quality of Life:before and after the intervention,patients in both groups showed significant improvements in 10 dimensions of swallowing burden,willingness to eat,eating time,swallowing symptoms,verbal communication,fear of eating,mental health,social functioning,fatigue,sleep quality,and total QOL score（P<0.05）,while there was no difference in the dimension of food choice（P>0.05）.When compared between the two groups after the intervention,the test group showed significantly better improvement than the control group in five dimensions of swallowing burden,eating time,swallowing symptoms,verbal communication,sleep quality,and total score（P<0.05）,while there was no significant difference in six dimensions of eating intention,food choice,eating fear,mental health,social functioning,and fatigue compared with the control group（P>0.05）.Conclusion1.Liuzijue can improve the swallowing function of patients with phlegm-stasis obstruction type ischemic stroke with swallowing disorder.2.Liuzijue can improve the breathing ability of patients with phlegm-stasis blocking ischemic stroke swallowing disorder,which helps to enhance the control of breathing during swallowing and promote the recovery of swallowing disorder.3.Liuzijue can improve the quality of life of patients with phlegm-stasis blocking ischemic stroke with swallowing disorder.