表面肌电生物反馈联合吞咽训练在脑梗死恢复期吞咽障碍患者康复中的应用

The effect of sEMG biofeedback combined with swallowing training in treatment of dysphagic patients with cerebral infarction at recovery stage

目的观察表面肌电生物反馈（sEMG-BFB）联合吞咽训练对脑梗死恢复期吞咽障碍患者康复的影响。方法选取脑梗死恢复期吞咽障碍患者51例，按随机数字表法将其分为常规训练组（26例）和生物反馈组（25例）。常规训练组给予口颜面功能训练、导管球囊扩张术、电刺激及吞咽功能训练等常规康复治疗，生物反馈组在此基础上，将吞咽功能训练改为在sEMG-BFB下进行。训练前、后，采用吞咽造影观察患者食管上段括约肌（UES）的开放情况，并行功能性经口摄食评估（FOIS）。结果训练前，2组患者FOIS评分、UES开放程度之间比较，差异均无统计学意义（P〉0．05）。训练后，2组FOIS评分均较组内训练前有所提高（P〈0．05），且生物反馈组训练后FOIS评分[（3．76±1．42）分]高于常规训练组[（2．77±1．42）分]（P〈0．05）。训练后，常规训练组UES完全开放和不完全开放的例数分别为18例和8例，生物反馈组训练后完全开放和不完全开放的例数分别为20例和5例，与组内训练前比较，差异均有统计学意义（P〈0．05）。结论在常规康复训练的基础上辅以sEMG-BFB治疗，有助于改善脑梗死恢复期吞咽障碍患者UES的开放情况，提高其吞咽功能。

Objective To observe the effect of surface electromyographic biofeedback （sEMG-BFB） combined with routine swallow training on dysphagic patients with cerebral infarction at recovery stage. Methods Fiftyone dysphagic patients with cerebral infarction were randomly divided into two groups： control group （26 cases） and biofeedback training group （25 cases）. The control group was given routine training including orofacial function train- ing, balloon dilatation and behavioral swallowing training, while the biofeedback training group was given behavioral swallowing training was conducted with the guidance of sEMG-BFB in addition to the routine training. Before and after the treatment, videofluoroscopy swallowing study （VFSS） was performed to observe the opening of upper esophageal sphincter （UES）. Functional oral intake scale （FOIS） was used to evaluate swallow function. Results Before treatment, there were no significant difference between the two groups in terms of FOIS score and UES opening （P 〉 0.05）. The FOIS score increased in both groups after treatment （P 〈 0.05 ） , and the FOIS score was higher in the biofeedback training group than that of the control group （P 〈 0.05 ）. After treatment, the number of UES complete opening and incomplete opening was 18 and 8, respectively, in the control group, versus 20 and 5, respectively, in the biofeedback training group. UES opening improved in both groups after treatment （ P 〈 0.05 ）. Conclusion Routine swallowing training combined with sEMG-BFB can benefit the dysphagic patients with cerebral infarction for their UES opening and swallowing ability at recovery stage.