| Research purpose:To compare and analyze the effects of ice stimulation,citric acid stimulation and combined ice and citric acid stimulation on swallowing dysfunction,duration of nasal feeding tube retention and nasal cannula placement rate,and quality of life of patients after ischemic stroke based on swallowing function rehabilitation.Materials ad Methods:In this study,a completely randomized controlled trial design was used to select patients with swallowing disorders after ischemic stroke who were admitted to the neurology and rehabilitation departments from November 1,2021 to November 31,2022 in a tertiary hospital in Chengdu,and the patients were treated according to the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018,based on the daily application of swallowing function rehabilitation.Patients who met the inclusion and exclusion criteria were randomly grouped using a random number table: group A(ice stimulation group,n1=37),group B(citric acid stimulation group,n2=37),and group C(combined ice and citric acid stimulation group,n3=36);the interventions were: three rounds of swallowing function rehabilitation training(10min/time),and then three rounds of ice stimulation(10 min/time)according to the patient’s group.The interventions were: 3 rounds/time(10 min/time)of swallowing rehabilitation,followed by 5 rounds/time(10-15 min/time)of ice stimulation,5rounds/time(10-15 min/time)of citric acid stimulation,and 5 rounds/time(20-30min/time)of combined ice and citric acid stimulation,twice daily for 2 weeks of continuous intervention.The results of the water swallowing test,GUSS score results,duration of nasal feeding tube retention and nasal cannula placement rate,and swallowing-quality-of-life assessment were compared among the three groups of patients 1 day before and 14 days after the intervention.Result:A total of 114 patients were collected in this study,including 39 patients in group A,38 patients in group B,and 37 patients in group C.During the study,2 patients(5.4%)were excluded from group A,1 patient(2.7%)from group B,and 1 patient(2.78%)from group C due to change of condition and transfer.During the study,2 cases(5.4%)were excluded from group A,1 case(2.7%)from group B,and 1 case(2.78%)from group C due to change of condition and transfer to other hospitals,and finally a total of110 patients were included in the complete study data.1.Comparison of baseline data of patients in the three groups: comparative analysis of basic demographic data,such as gender,age,and education level,as well as other study-related data,such as hypertension and diabetes mellitus,were not statistically significant(P>0.05)and were comparable between groups.2.Comparative analysis of the results of the water drinking test in the three groups after intervention: the results showed that the total effective rate of group A was 64.9%,the total effective rate of group B was 81.1%,and the total effective rate of group C was91.7%,and the difference was statistically significant(P<0.05)when comparing the effective rate of the water drinking test in the three groups after intervention;after further two-by-two comparison between groups,the results showed that the effective rate of the water drinking test in group C was higher than that in group The difference was not statistically significant(P>0.017)when comparing the effective rate of the water drinking test in group C with that in group B.The difference was statistically significant when comparing the effective rate of the water drinking test in group C with that in group A(P<0.017).3.Comparative analysis of the GUSS scores: The results of intra-group comparison showed that the GUSS scores of the three groups were higher than those before the intervention(P<0.05).For the comparison between groups,the results showed that the differences were not statistically significant(P>0.05)when comparing the GUSS scores of patients in the three groups before the intervention;the differences were statistically significant(P<0.05)when comparing the GUSS scores of patients in the three groups after the intervention;further two-by-two comparison of the scores of patients in the three groups after the intervention showed that the GUSS scores of patients in group C were higher than those in groups A and B,respectively(P< 0.05),and the difference between the scores of group A and group B was not statistically significant(P>0.05).4.Comparative analysis of the nasal feeding tube retention time and nasal feeding tube placement rate in three groups of patients: the results showed that the difference was statistically significant(P<0.05),when comparing the nasal feeding tube retention time in the three groups after the intervention;further,the results showed that the nasal feeding tube retention time in group C was shorter than that in groups A and B,respectively(P<0.05),and the difference was not statistically significant when comparing the nasal feeding tube retention time in groups A and B(P>0.05).The difference was not statistically significant(P>0.05).intra-group comparison,the results showed that the nasal feeding tube placement rate in the three groups was lower than that before the intervention(P<0.05).The comparison between groups showed that the difference was not statistically significant(P>0.05)when comparing the nasal feeding tube placement rates of patients in the three groups before intervention;the difference was statistically significant(P<0.05)when comparing the nasal feeding tube placement rates of patients in the three groups after intervention;further two comparisons between groups showed that the nasal feeding tube placement rates in group C were lower than those in groups A and B,respectively(P<0.05),and the nasal feeding tube placement rates in groups A and B were There was no statistically significant difference in the nasal cannula placement rate between groups A and B(P>0.05).5.Comparative analysis of the SWAL-QOL scores: The results of the intra-group comparison showed that the SWAL-QOL scores of the three groups were higher than those before the intervention(P>0.05).For the comparison between groups,the results showed that the differences in SWAL-QOL scores before the intervention were not statistically significant(P>0.05);the differences in SWAL-QOL scores after the intervention were statistically significant(P<0.05),except for the verbal communication dimensions,which were not statistically significant(P>0.05);further,the differences in SWAL-QOL scores after the intervention were statistically significant(P<0.05).The results showed that the SWAL-QOL scores of patients in group C were higher than those in groups A and B(P<0.05),and the difference was statistically significant(P<0.05);only the mental health dimension scores in group B were higher than those in group A(P<0.05),and the difference between the scores of other dimensions in both groups was not statistically significant(P>0.05).ConclusionIce stimulation,citric acid stimulation,and combined ice and citric acid stimulation based on swallowing rehabilitation all helped to improve swallowing function,shorten the retention time of nasal feeding tube,and improve quality of life in patients with swallowing dysfunction after ischemic stroke.Combined ice and citric acid stimulation was more effective than ice or citric acid stimulation alone in reducing the risk and degree of swallowing dysfunction,shorten the retention time of nasal feeding tube,reducing the rate of nasal cannula placement,and improving quality of life in patients after ischemic stroke;patients had better mental state when receiving citric acid stimulation compared with ice stimulation. |
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