脑卒中后吞咽障碍患者颏下肌群的表面肌电信号特征分析

Surface electromyographic activities of submental muscles among stroke patients with dysphagia

目的探讨脑卒中后吞咽障碍患者吞咽活动时颏下肌群表面肌电图（sEMG）的信号特征，为脑卒中后吞咽障碍患者的康复评估及临床治疗提供依据。方法收集2010年10月至2012年7月中山大学孙逸仙纪念医院康复科及神经科第一次诊断为脑卒中的住院患者27例，分为吞咽障碍组（15例）及无吞咽障碍组（12例），另招募年龄和性别与之相匹配的健康受试者14名为健康对照组。采用sEMG进行检查，记录单次吞咽5ml和10ml的稀流质和糊状食物时颏下肌群的sEMG信号特征，主要分析指标为吞咽动作完成的时限（s）、吞咽时颏下肌群收缩的平均波幅（恤v）和峰值（μV）。组间数据比较采用单因素方差分析。结果三组受试者在吞咽各种不同容积和不同性状的食物时，脑卒中后吞咽障碍患者的吞咽时限[分别为（1．38±0．21）s，（1．66±0．30）s，（1，46±0．24）s，（1．78±0．28）s]明显长于脑卒中后无吞咽障碍患者及健康受试者（P〈0．05），脑卒中后吞咽障碍患者的平均波幅[分别为（16±6）μV，（15±5）μV，（20±13）μV，（19±7）μV]小于脑卒中后无吞咽障碍患者及健康受试者（P〈0．05），脑卒中后吞咽障碍患者的峰值[分别为（48±23）μV，（51±23）μV，（51±31）μV，（63±32）μV]小于脑卒中后无吞咽障碍患者及健康受试者（P〈0．05）。结论sEMG可有效筛查出脑卒中后吞咽障碍患者，并可定量检测吞咽肌收缩力，是脑卒中后吞咽障碍患者床边评估和早期诊断的一种安全有效手段。

Objective To explore the swallowing functions of stroke patients with dysphagia. Methods A total of 41 subjects were recruited. There were 15 stroke patients with dysphagia, 12 stroke patients without swallowing disorders and 14 age-and gender-matched healthy controls. Surface electromyography （sEMC） was employed over the suprahyoid muscle group. Single swallow was applied twice with 5 and 10 ml of thin liquid barium as well as 5 and 10 ml of paste barium. The duration, average amplitude of sEMG and peak amplitude of submental muscle contraction were compared among three groups. Three-way analysis of variance （ANOVA） was performed. Results No significant differences existed in the general data among three groups （P 〉 0. 05）. However, all volumes, consistencies and durations （1.38±0.21）, （1.66±0.30）, （1.46±0.24）, （1.78 ±0.28） s] were signifieantlylonger for the group of dysphagia patients than for those without dysphagia and healthy subjects （ P 〈 0. 05 ） . And the average amplitudes （ （ 16 ± 6 ） , （ 15 ± 5 ） , （ 20 ± 13 ） , （ 19 ± 7 ） μV ） were significantly smaller for the group of dysphagia patients than for those without dysphagia and healthy subjects （ P 〈 0. 05 ） while the peak amplitudes （（48 ± 23 ）, （51 ±23 ）, （51 ± 31 ）, （63 ± 32）μV） were significantly smaller for the group of dysphagia patients than for those without dysphagia and healthy subjeets （ P 〈 0. 05 ） . There were no signifieant differences between patients without dysphagia and those of healthy subjeets （P 〉0. 05）. Conclusion As a simple and useful tool, sEMG is feasible for evaluating swallowing function and quantifying the strength of swallowing museles in post-stroke patients with dysphagia.