神经肌肉电刺激治疗脑损伤后吞咽障碍的疗效观察

Neuromuscular electrical stimulation for swallowing disorders caused by brain injury

目的观察神经肌肉电刺激治疗脑损伤后吞咽障碍的疗效。方法按随机数字表法将急性脑损伤后发生吞咽障碍的患者64例分为A组（n=21）、B组（n=22）和C组（n=21例）。3组患者均采用神经内科常规药物治疗和常规护理，在此基础上均采用不同参数的神经肌肉电刺激。治疗参数：A组波宽（T）为700ms，脉冲间歇（R）为2S，频率为0．19Hz；B组患者T为700ms，R为1S，频率为0．29Hz；C组患者T为340ms，R为400ms，频率为0．68Hz。3组患者均于治疗前和治疗4周后（治疗后）采取洼田饮水试验对其吞咽障碍的症状进行分级评定。结果治疗前，3组患者的洼田饮水试验评分差异无统计学意义（P〉0．05）。治疗后，A组、B组和c组与各自治疗前相比，评分均有降低，差异均有统计学意义（P〈0．01）；A组的疗效显著优于B组和C组，而B组的疗效也优于c组，差异均有统计学意义（P〈0．05）。A组总有效率为80．95％优于B的72．73％和C组的66．67％，且B组总有效率亦优于C组，差异均有统计学意义（P〈0．05）。结论神经肌肉电刺激疗效肯定，其中以T为700ms，R为2s，频率为0．19Hz的低频刺激的疗效最为显著。

Objective To evaluate the effect of neuromuscular electrical stimulation （NMES） on swallo- wing function in brain injury patients with dysphagia. Methods Sixty-four patients with dysphagia were divided into A group （n=21, stimulated with T =700 ms, R =2 s, frequency =0. 19 Hz）, B group （n =22, T = 700 ms, R = 1 s, frequency = 0. 29 Hz） , and C group （ n = 21 , T = 340 ms, R = 400 ms, frequency = 0.68 Hz）. One pair of electrodes was placed at the midline under the chin over the submental muscle group. The intensity of stimulation ranged from 5 to 11 mA. The treatments were once a day, 5 times a week, with 20 times as one course. The results were assessed with Kubota＇s water swallowing test before and 4 weeks after treatment. Results The water swallowing test scores were significantly reduced after treatment in all 3 groups, with signifi- cantly greater reductions in A group compared with B and C group. The effectiveness rate was 81% in A group, 73% in B group and 67% in C group, all statistically significant differences. Conclusion NMES can be an effective and safe treatment for dysphagia after brain injury. NMES appears to be most effective with T = 700 ms, R = 2 s, and a frequency of 0.19 Hz.