| BackgroundThe prevalence of swallowing disorders after stroke is as high as 50% to 70%,and cricopharyngeus achalasia(CPA)accounts for about 80% of swallowing disorders after a brainstem stroke.Balloon catheter dilatation is a common rehabilitation interventional technique in clinical treatment of CPA.Although it has the advantages of low cost,simple operation and high efficiency,patients are prone to adverse reactions such as aspiration,blocked balloon swallowing,tension and anxiety during the treatment.Since breathing and swallowing share common muscle and anatomical pathways in the human body,respiratory function training has gradually developed as a new method to improve patients’ swallowing function.The application of respiratory function training in the process of balloon dilatation therapy can make up for the deficiency of balloon dilatation therapy to a certain extent.ObjectiveThe objective was to improve the safety and efficacy of balloon catheter dilatation and formulate a swallowing rehabilitation program suitable for CPA patients after stroke in China.In addition,the effectiveness of this program on bucking,the ability of oral intake and swallowing,quality of life,mood states and the comfort level during dilatation treatment were explored,so as to provide reference for the recovery of swallowing function in CPA patients after stroke.MethodsThis study is a quasi-experimental study.From October 2021 to October 2022,forty-eight CPA patients after stroke were recruited through purposive sampling.The control group(n=24)received routine swallowing rehabilitation training and balloon catheter dilatation,and the patients in the intervention group(n=24)received routine swallowing rehabilitation training and a combined intervention program of balloon catheter dilatation and respiratory function training.Intervention started on the second day after the patients were diagnosed with CPA,and ended when the cricopharyngeus muscle reopened or when patients were discharged from the hospital.Outcome indicators included bucking,the ability of oral intake and swallowing,quality of life,mood states and the comfort level during dilatation therapy.The investigation tools included general information questionnaire,Water Swallowing Test(WST),The Functional Oral Intake Scale(FOIS),The Modified Mann Swallowing Ability Assessment Form(MMASA),Swallowing-related Quality of Life(SWAL-QOL),Hospital Anxiety and Depression Scale(HADS)and Visual Analogue Scales(VAS).SPSS 24.0 was used for the statistical analysis.Results1.Implementation of the intervention program: During the study,one patient in the intervention group was transferred to ICU for observation due to aggravated conditions,while one patient in the control group withdrew from the study because of the difficulty in tolerating balloon catheter dilatation.The sample effective rate was95.83%.2.Baseline data comparison results: No statistically significant differences were observed in general demographic data between the two groups,such as gender,age,educational level and marital status,as well as disease-related information such as stroke type,disease duration,lesion side and chronic disease history(P>0.05).At the same time,there was no significant difference between the two groups in the bucking,the ability of oral intake and swallowing,quality of life and mood states(P>0.05),which were comparable.3.Effectiveness of the combined intervention program of balloon catheter dilatation and respiratory function training on bucking and oral intake ability in CPA patients: The results of intra-group analysis showed that both single dilatation therapy and combined intervention program significantly improved WST rating and FOIS grading in CPA patients(P<0.001).The results of inter-group analysis showed that compared with single dilatation therapy,the combined intervention could significantly reduce the WST rating and improve the FOIS grading of CPA patients(P<0.05).There was no statistically significant difference in the total effective rate of recovery of bucking between the two groups(P=0.714).4.Effectiveness of the combined intervention program of balloon catheter dilatation and respiratory function training on swallowing ability and quality of life in CPA patients: The results of intra-group analysis showed that both combined intervention program and single dilatation therapy significantly improved MMASA scores and SWAL-QOL scores in CPA patients(P<0.001).The results of inter-group analysis showed that the combined intervention program could significantly improve the MMASA score and SWAL-QOL score of CPA patients compared with single dilatation therapy(P<0.05).5.Effectiveness of the combined intervention program of balloon catheter dilatation and respiratory function training on mood states and the comfort during dilatation therapy: The results of intra-group analysis showed that compared with the value before intervention,the HADS score of CPA patients received single dilatation treatment was significantly enhanced(P<0.05).The HADS score of patients in the intervention group was higher than the value before treatment,however,the difference was not significant(P>0.05).In addition,the results of inter-group analysis showed that the HADS score of CPA patients who received combined intervention program was significantly lower than that of patients who received single dilatation therapy(P<0.001).Compared with the single dilatation therapy,combined intervention program could significantly improve the comfort during dilatation treatment(P<0.001).Conclusion1.The combined intervention program of balloon catheter dilatation and respiratory function training has a similar overall effective rate of the recovery of bucking as the single dilatation therapy.2.Compared with single dilatation therapy,the combined intervention program of balloon catheter dilatation and respiratory function training can significantly improve bucking,the ability of oral intake and swallowing,quality of life,mood states and the comfort level during dilatation treatment in patients with CPA.3.The combined intervention program of balloon catheter dilatation and respiratory function training can significantly relieve the anxiety and depression caused by dilatation therapy in CPA patients. |
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