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目的 研究多学科合作干预对帕金森吞咽障碍(PD-D)患者吞咽功能、舌骨喉复合体动度的影响。方法 选取2023年1月～2023年12月于南京医科大学附属脑科医院治疗的PD-D患者106例，依据随机数表法将患者分为观察组(n=53)、对照组(n=53),对照组行常规干预，观察组在常规干预基础上行多学科合作干预。观察两组患者临床疗效。观察两组患者干预前后血红蛋白(Hb)、血清总蛋白(TP)及血清白蛋白(ALB)等营养状况指标；舌骨、甲状软骨移动幅度等舌骨喉复合体动度指标。记录两组患者噎食、误吸、吸入性肺炎等PD-D并发症。结果 观察组总有效率(92.45%)大于对照组(75.47%),差异有统计学意义(χ2=5.621,P<0.05)。干预后，观察组Hb、TP及ALB水平均高于对照组[(130.32±15.26)g/L vs.(115.38±13.24)g/L、(69.74±7.21)g/L vs.(61.34±6.33)g/L、(37.58±3.92)g/L vs.(34.70±3.58)g/L],差异有统计学意义(t=5.384、7.133、5.321,P<0.05)。干预后，观察组甲状软骨上移幅度、甲状软骨前移幅度、舌骨前移幅度、舌骨上移幅度均大于对照组[(23.86±2.57)mm vs.(15.55±1.82)mm、(9.67±0.98)mm vs.(4.82±0.53)mm、(8.92±0.91)mm vs.(4.72±0.52)mm、(19.02±2.11)mm vs.(12.67±1.47)mm],差异有统计学意义(t=19.211、31.69、29.173、17.977,P<0.05)。观察组PD-D并发症发生率低于对照组(3.77%vs.20.75%),差异有统计学意义(χ2=7.035,P<0.05)。结论 多学科合作干预可增强PD-D患者吞咽功能，提高其营养水平，改善患者舌骨喉复合体动度，减少PD-D并发症。
Abstract：Objective To investigate the effects of multidisciplinary intervention on swallowing function and hyolaryngeal complex movement in patients with Parkinson's disease dysphagia(PD-D). Methods One hundred and six PD-D patients treated in Nanjing Medical University Affiliated Brain Hospital from Jan 2023 to Dec 2023 were selected and divided into an experimental group(n=53)and a control group(n=53)according to the random number table method. The control group received routine intervention, and the experimental group underwent multidisciplinary cooperative intervention based on routine intervention. The clinical effects of the two groups were observed. Choking, aspiration, aspiration pneumonia, and other PD-D complications were recorded. The nutritional status indexes of hemoglobin(Hb),serum total protein(TP),and serum albumin(ALB),and the movement of the hyoid bone and thyroid cartilage and other parameters of the hyolaryngeal complex before and after intervention were observed. Results The total effective rate of the experimental group was higher than that of the control group(χ2=5.621,P < 0.05). After intervention, the levels of Hb, TP, and ALB in the experimental group were higher than those in the control group(t=5.384,7.133,5.321,P < 0.05). After the intervention, the amplitude of thyroid cartilage upward movement, thyroid cartilage forward movement, hyoid forward movement, and hyoid upward movement in the experimental group were greater than those in the control group(t=19.211,31.69,29.173,17.977,P < 0.05). The incidence of PD-D complications in the experimental group was lower than that in the control group(χ2=7.035,P < 0.05). Conclusion Multidisciplinary intervention can enhance the swallowing function and improve the nutritional level of PD-D patients, improve the hyolaryngeal complex mobility, and reduce the complications of PD-D.
[1] Cosentino G,Todisco M,Giudice C,et al.Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease[J].Curr Opin Neurol,2022,35(6):741-752.
[2] Warnecke T,Sch?fer KH,Claus I,et al.Gastrointestinal involvement in Parkinson's disease:pathophysiology,diagnosis,and management[J].NPJ Parkinsons Dis,2022,8(1):31.
[3] Han Y,Peng G,Liu L,et al.Multidisciplinary cooperative first aid model for the treatment of patients with pelvic and multiple fractures[J].Pak J Med Sci,2022,38(3Part-I):560-564.
[4] Hirschwald J,Hofacker J,Duncan S,et al.Swallowing outcomes in dysphagia interventions in Parkinson's disease:a scoping review[J].BMJ Evid Based Med,2023,28(2):111-118.
[5] 中华医学会神经病学分会帕金森病及运动障碍学组，中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准(2016版)[J].中华神经科杂志，2016,49(4):268-271.
[6] Cosentino G,Avenali M,Schindler A,et al.A multinational consensus on dysphagia in Parkinson's disease:screening,diagnosis and prognostic value[J].J Neurol,2022,269(3):1335-1352.
[7] Gandhi P,Steele CM.Effectiveness of interventions for dysphagia in Parkinson disease:a systematic review[J].Am J Speech Lang Pathol,2022,31(1):463-485.
[8] Nielsen SS,Christensen JR,S?ndergaard J,et al.Feasibility assessment of an occupational therapy lifestyle intervention added to multidisciplinary chronic pain treatment at a Danish pain centre:a qualitative evaluation from the perspectives of patients and clinicians[J].Int J Qual Stud Health Well-being,2021,16(1):1949900.
[9] Cheng I,Sasegbon A,Hamdy S.Dysphagia treatments in Parkinson's disease:a systematic review and meta-analysis[J].Neurogastroenterol Motil,2023,35(8):e14517.
[10] Cattaneo C,Flynn é,Walshe M.Fidelity in behavioral interventions for oropharyngeal dysphagia in Parkinson's disease:a systematic review[J].Dysphagia,2022,37(2):307-317.
[11] Helliesen JS,Kristiansen I,Brekke HK,et al.Nutrition impact symptoms and the risk of malnutrition in people with Parkinson's disease:a cross-sectional study[J].J Hum Nutr Diet,2023,36(1):40-50.
[12] Jiayu L,Minmin W,Zhu L.Meta-analysis of the therapeutic effect of acupuncture on dysphagia in patients with Parkinson disease[J].Medicine(Baltimore),2023,102(51):e36698.
[13] Huang PL,Wang SJ,Sun RF,et al.Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation:a case-control study[J].Neural Regen Res,2022,17(5):1051-1058.
[14] Gandor F,Berger L,Gruber D,et al.Dysphagia in Parkinsonian syndromes[J].Nervenarzt,2023,94(8):685-693.
[15] Ambrocio KR,Miles A,Bhutada AM,et al.Defining normal sequential swallowing biomechanics[J].Dysphagia,2023,38(6):1497-1510.
[16] Carbo AI,Brown M,Nakrour N.Fluoroscopic swallowing examination:radiologic findings and analysis of their causes and pathophysiologic mechanisms[J].Radiographics,2021,41(6):1733-1749.
基本信息:
DOI：
中图分类号:R742.5
引用信息:
[1]罗媛榕,胡方婷,史秀秀等.多学科合作干预对帕金森吞咽障碍患者吞咽功能、舌骨喉复合体动度的影响[J].中华保健医学杂志,2024,26(05):581-584.
基金信息:
江苏省科技攻关项目专项资金(BE2022049-1)