吞咽功能训练结合神经肌肉电刺激对神经源性吞咽功能障碍疗效的影响

Treating neurogenic dysphagia

目的观察吞咽功能训练结合神经肌肉电刺激（NMES）治疗神经源性吞咽功能障碍（ND）的疗效，探讨ND治疗的更佳方案。方法采用随机数字表法将82例患者分为3组，吞咽功能训练组（吞咽训练组）根据吞咽受累不同部位采用相应的训练方法，包括口颜面功能训练、咽部冷刺激、门德尔松吞咽法训练等，每日1次，每次30min，10次为1个疗程；NMES组在吞咽功能障碍发生部位予以低频电刺激治疗，采用双向方波，波宽为700ms，频率范围在30～80Hz可调，电流强度为0～15mA，每日1次，每次30min，10次为1个疗程；综合治疗组（综合组）采用吞咽功能训练加NMES疗法。治疗前、后进行X线透视吞咽功能检查（VFSS），根据VFSS评分进行吞咽功能分级。结果2个疗程后，3组患者吞咽功能均有不同程度的提高，吞咽训练组总有效率为73％、NMES组总有效率为83％、综合组总有效率为94％；综合组的＂VFSS分级结果显示，其吞咽功能明显优于吞咽训练组和NMES组（P〈0．05）。结论吞咽功能训练加NMES治疗能更好地改善ND患者的吞咽功能，尤其是对假性延髓麻痹患者效果明显。

Objective To explore the best treatment program for neurogenic dysphagia （ND） by observing the efficacy of three different rehabilitation programs. Methods Eighty-two dysphagic patients were randomly divided into a swallowing training group （which received mouth, facial, and tongue function training along with cold stimulation of the pharynx, Mendelson＇s swallowing training, and swallowing behavior coordination training） and a group which received neuromuscular electrical stimulation （NMES） only. Low-frequency NMES was applied at the location of the swallowing obstacle using a biphase square wave 700ms long at 30-80 Hz with a current intensity of 0-15 raA. There was also a combined treatments group which received swallowing behavior therapy combined with NMES. All three groups were treated for 30 rain daily for 20 days. Videofluoroscopy （VFSS） was conducted before and after treatment to assess swallowing function. Results After 20 days of treatment, swallowing function had improved in all three groups. The effectiveness rate was 73% in the swallowing training group, 83% in the NMES group and 94% in the combined treatment group. The average VFSS score in the combined therapy group was significantly higher than that of either the swallowing training or NMES group. Conclusions NMES combined with swallowing behavior therapy can greatly improve swallowing function in patients with neurogenic dysphagia, especially those with pseudosuoranuclear oaralvsis.