强化神经肌肉电刺激联合吞咽功能训练治疗脑卒中后吞咽功能障碍的疗效观察

Electrical stimulation and swallowing training in treating post-stroke dysphagia

目的观察不同强度的神经肌肉电刺激（NMES）对卒中后吞咽功能障碍患者的影响。方法将30例咽期吞咽功能障碍患者按随机数字表法分为对照组、NMES组和强化NMES组，每组10例。3组患者均给予常规吞咽功能训练，NMES组和强化NMES组在此基础上辅以神经肌肉低频电刺激，NMES组每日1次，强化NMES组每日2次。治疗前、治疗2周及4周后采用洼田饮水试验和视频透视吞咽检查（VFSS）对疗效进行评定。结果治疗2周后，强化NMES组治疗显效率明显高于对照组，差异有统计学意义（P〈0．05）；治疗2周后，各组患者VFSS评分均较治疗前增高（P〈0．05）；与对照组治疗2周后比较，NMES组[（8．100±1．287）分]和强化NMES组[（9．000±0．943）分]VFSS评分均高于对照组[（7．200±1．814）分]（P〈0．05），且强化NMES组VFSS评分高于NMES组（P〈0．05）。结论NMES可明显提高脑卒中患者的吞咽反射水平及咽部肌肉的收缩功能，增强吞咽再学习的训练疗效，在吞咽功能训练基础上，强化NMES的疗效优于NMES。

Objective To observe the effects of neuromuscular stimulation （NMES） intensity on post-stroke dysphagia. Methods Thirty patients with dysphagia resulting from a stroke were randomly divided into a control group, an NMES group, and an intensive NMES group, with 10 patients in each. The 3 groups all received conven- tional swallowing training. Patients in the NMES group also received NMES once a day and those in the intensive NMES group received it twice a day. Kubota＇s water drinking test and videofluoroscopy were used to assess the subjects＇ swallowing function before treatment and after 2 and 4 weeks of treatment. Results After 2 weeks, the average water drinking test score was significantly better in the intensive NMES group than in the control group. The fluoroscopic resuhs of all three groups had improved significantly, but the results in the NMES group and the intensive NMES group were significantly better than those of the control group. The intensive NMES group also scored signifi- cantly higher than the NMES group. Conclusion NMES can improve the swallowing reflex and the contraction of the suprahyoid muscles. It can strengthen the effect of re-learning swallowing. Two NMES sessions a day are better than one.