肌电生物反馈治疗脑卒中后吞咽障碍的疗效观察

The effects of electromyographic biofeedback in the treatment of dysphagia after stroke

目的观察肌电生物反馈治疗脑卒中后吞咽障碍的临床疗效。方法采用随机数字表法将脑卒中后吞咽障碍患者分为对照组、电刺激组及肌电生物反馈组。对照组患者给予单纯吞咽功能训练，电刺激组及肌电生物反馈组在常规吞咽训练基础上分别给予电刺激或肌电生物反馈治疗，每周治疗5次，共持续治疗3周。于治疗前、治疗3周后分别采用表面肌电图（sEMG）和标准吞咽功能评估法（SSA）对各组患者吞咽功能进行评定。结果3组患者分别经3周治疗后，发现其sEMG平均波幅、吞咽时限及SSA评分均较治疗前明显改善（P〈0．05）；并且肌电生物反馈组及电刺激组sEMG平均波幅[分别为（25．96±2．49）μV和（22．71±4．29）μV]、吞咽时限[分别为（1．15±0．11）s和（1．25±0．11）s]及SSA评分[分别为（22．40±3．46）分和（27．39±4．58）分]均显著优于对照组（P〈0．05）；同时肌电生物反馈组上述疗效指标亦显著优于电刺激组（P〈0．05）。结论肌电生物反馈治疗可显著改善脑卒中患者吞咽功能，其疗效明显优于电刺激及单纯吞咽功能训练。

Objective To investigate the efficacy of electromyographic biofeedback therapy （EMGBFT） in treating dysphagia after stroke. Methods Patients diagnosed with dysphagia after stroke were recruited and randomly divided into a control group （ n = 22） , an electrostimulation group （ ES, n = 25 ） and an EMGBFT group （ n = 23）. The control group received conventional treatment, while the patients in the other groups additionally received Vitalstim ES or EMGBFT 5 times per week for 3 weeks. Before and after the trial, deglutition function was evaluated through surface electromyography （sEMG） and using a standardized swallowing assessment （SSA）. Results After 3 weeks of treatment, the mean sEMG amplitude, deglutition duration and SSA score and improved significantly in comparison to the baseline in all three groups. All were also significantly better in the two treatment groups than in the control group. Importantly, the mean sEMG amplitude, deglutition duration and SSA score were all significantly better in the EMGBFT group than in the ES group. Conclusion EMGBFT can promote better deglutition among patients with dysphagia after stroke more effectively than ES or conventional treatment.