目的 :观察在对脑损伤后吞咽功能障碍并发认知功能障碍患者进行康复治疗过程中认知功能训练对患者吞咽功能改善程度的影响。方法 :对60例脑损伤后吞咽功能障碍患者进行综合性吞咽功能训练,对其中并发认知功能障碍的32例患者还同时进行认知功能训练。采用洼田饮水试验、标准吞咽功能评估量表和X线荧光透视吞咽检查进行吞咽功能障碍程度评定,并分析认知功能正常与障碍患者在吞咽功能改善程度上的差异。结果 :经4周康复治疗,并发认知功能障碍患者的吞咽功能改善程度不如单纯吞咽功能障碍患者,但与康复治疗前相比仍较明显。结论 :对并发认知功能障碍的吞咽功能障碍患者,认知功能的提高对其吞咽功能的改善也有重要意义。

Objective:To analyze the reason of the difference of clinical curative effect after rehabilitation treatment for stroke patients with dysphagia.Methods:A total of thirty stroke patients with dysphagia were evaluated with standardized swallowing assessment (SSA), video fluoroscopic swallowing study (VFSS) and swallowing disorder patient's quality of life scale (SWAL-QOL).Results:After four weeks of rehabilitation treatment, the SSA, VFSS and SWAL-QOL scores were significantly increased (P<0.01), and the SWAL-QOL score was lower than the SSA or VFSS score, but there was not a significant difference among them.Conclusion:A reason for the differences of SSA, VFSS and SWAL-QOL is the objectivity and subjectivity of curative evaluation. SWAL-QOL score is focus on the subjective effect and lower, suggesting that for patients with dysphagia, the psychological burden of swallowing disorder has a significant impact on the clinical outcome of patients.

目的:探讨岛盖综合征的主要临床特征和恢复规律,优化岛盖综合征的临床诊断和康复干预方法.方法:收集13例门诊或住院的岛盖综合征患者,用口面失用量表、Frenchay构音障碍评定法等量表,在首次门诊或入院后第1天、出院前1天评定患者,根据入院后第1天康复评定的结果予以住院患者个体化的康复干预.结果:8例皮质型患者的皮质病损部位累及单侧或双侧岛盖;所有患者首诊或入院时口面失用量表评定均提示有显著的口、面、舌肌的自主运动障碍,住院患者经康复干预后口面失用量表评分显著性增高,9例入院时为鼻饲营养的住院患者经康复治疗后有6例患者改为经口进食,约占66.7％;所有患者首诊或入院时均表现为重度构音障碍,10例住院患者经20天以上的康复训练,仍为重度构音障碍.结论:口腔期吞咽障碍和重度构音障碍是岛盖综合征患者重要临床特征,大多数岛盖综合征患者经康复治疗能恢复经口进食,而构音障碍却很难恢复.