不同强度神经肌肉电刺激治疗脑性瘫痪吞咽障碍的研究

Effects of different intensity neuromuscular electrical stimulation on dysphagia in children with cerebral palsy

目的:对不同强度神经肌肉电刺激(neuromuscular electrical stimulation,NMES)治疗脑瘫吞咽障碍患儿临床效果进行分析。方法:将脑瘫吞咽障碍患儿60例随机分为NMESⅠ组、NMESⅡ组、NMESⅢ组和对照组(每组各15例),其中对照组患儿给予常规康复训练,NMES组在常规康复训练基础上分别给予10mA、15mA、20mA不同强度NMES治疗共12周。分析4组患儿在治疗前后吞咽障碍严重程度、营养状况改善程度。运用表面肌电图测定颌下肌群sEMG中吞咽时程及平均振幅改变。结果:4组患儿治疗后较治疗前吞咽障碍评分改善,差异具有显著性(P<0.05),NMES组吞咽障碍评分较对照组有显著改善(P<0.05);NMES组总有效率较对照组有所提高,NMES组较对照组营养状况改善程度具有显著性意义,其中NMESⅢ组吞咽障碍及营养状况改善程度优于其他NMES组。sEMG平均振幅增高,吞咽时程缩短,差异具有显著性(均P<0.05),其中NMESⅢ组优于其他强度NMES组。结论:对脑瘫吞咽障碍患儿实施NMES治疗效果显著,有效改善吞咽障碍、营养状况、咽部肌肉收缩功能。在可耐受范围内,增加刺激强度,可提高治疗效果。

Objective: To analyze the clinical effect of different intensity neuromuscular electrical stimulation dysphagia in children with cerebral palsy.Method: Sixty patients with cerebral palsy complicating dysphagia were randomly divided into NMES groupⅠ,NMES groupⅡ, NMES groupⅢ and control group(15 cases in each group). The patients in the control group took routine rehabilitation training daily. Besides routine rehabilitation training, NMES group took neuromuscular electrical stimulation with different intensity(10 mA, 15 mA, 20 mA) for 12 weeks. The severity of dysphagia and the scores of nutritional status were evaluated before and after the treatment. Changes of swallowing time and average surface electromyography(sEMG) amplitude of submandibular muscle was analyzed.Result: There were significant improvements of the scores of dysphagia and the scores of nutritional status in4 groups(P<0.05).The improvement of the scores of dysphagia in the NMES groups was superior to the control group(P<0.05). The total effective rate of the NMES groups was higher than that of the control group(P<0.05). The scores of nutritional status in the NMES groups improved more than compared with the control group(P<0.05). The improvement of the scores of dysphagia and nutritional status in NMES group Ⅲ was statistically significant better than other NMES groups(P<0.05). The average amplitude of the sEMG increased,the duration of swallowing was shortened, while the NMES groups was better than the control group(P<0.05).NMES group Ⅲ(stimulation intensity 20 m A) was superior to other NMES groups(P<0.05).Conclusion: NMES is effective for dysphagia in children with cerebral palsy, which can improve the dysphagia, the nutritional status of children and the contraction of the suprahyoid muscles. Within the tolerable range,the greater the stimulation intensity the better the effect.