神经肌肉电刺激对脑卒中后吞咽障碍患者舌骨喉复合体动度的影响

Effect of neuromuscular electrical stimulation on hyolaryngeal structural movement in post-stroke dysphagia

目的观察神经肌肉电刺激（NMES）治疗脑卒中后吞咽障碍的临床疗效，对比分析不同部位电刺激对患者舌骨喉复合体动度的影响。方法采用随机数字表法将30例脑卒中后吞咽障碍患者分为治疗A组、治疗B组及对照组。3组患者均给予常规吞咽训练、药物治疗及一般康复治疗，治疗A组在此基础上辅以舌骨上、下区神经肌肉电刺激，治疗B组则辅以单纯舌骨上区神经肌肉电刺激。分别于治疗前、治疗2周后对各组患者进行电视X线透视吞咽功能检查，并测量吞咽半流质食物时其舌骨及甲状软骨向上、向前移动距离；同时采用洼田饮水试验、才藤分级、吞咽障碍结局与严重度量表（DOSS）对各组患者疗效进行评定。结果3组患者治疗后其洼田饮水试验分级、才藤分级、DOSS量表评分均较治疗前明显改善（P〈0．05）；治疗A组及治疗B组洼田分级[分别为（2．40±1．26）级和（2．10±0．99）级]、才藤分级[分别为（5．30±1．89）级和（5．20±1．69）级]、DOSS量表评分[分别为（5．20±1．40）分和（5．10±1．45）分]均显著优于对照组（P〈0．05），两电刺激组患者治疗后上述疗效指标组间差异均无统计学意义（P〉0．05）。治疗B组患者治疗后在吞咽半流质食物时其舌骨前移距离[（12．15±7．59）mm]较治疗前及治疗A组、对照组均明显增大（P〈0．05）。结论在常规吞咽训练基础上辅以神经肌肉电刺激呵显著改善脑卒中后吞咽障碍患者吞咽功能；将电极片放置在舌骨上区或舌骨上、下区刺激时其疗效问无显著差异，但单纯舌骨上区电刺激可进一步改善脑卒中患者吞咽时舌骨前移距离。

Objective To explore the effect of neuromuscular electrical stimulation（NMES） on hyolaryngeal structural movement in post-stroke dysphagia. Methods Thirty patients with post-stroke dysphagia were randomly divided into 3 groups （n = 10） namely group A, group B and group C. On the basis of routine swallowing training, medication and rehabiliation given to group C, group A was provided with VitalStim therapy on both suprahyoid and infrahyoid muscles, while group B was only on suprahyoid muscles lasting 2 weeks. Before and after treatment, the Video Fluoroscopy Swallowing Study （VFSS） was carried out and the upward and forward displacement distances of the hyoid and thyroid cartilage when swallowing pap were measured. Moreover, water swallow test, dysphagia severity scale and DOSS scores were used to assess the swallowing function. Results After 2 weeks＇ treatment, the water drinking test score, dysphagia severity scale and DOSS scores increased significantly in all groups than before treat- ment. The water drinking test score of group A （2.40± 1.26） and group B （2.10 ±0.99） , dysphagia severity scale of group A （5.30±1.89） and group B（5.20±1.69）, as well as the DOSS level of group A （5.20±1.40） and group B （5.10 ± 1.45） were significantly better than the control group. However, no significant difference was ob- served in all measurements between group A and group B. The group B revealed a significantly increase in anterior hyoid excursion distance of （12.15 ± 7.59） mm, much bigger than that before treatment and that of group A and B after treatment. Conclusion NMES on the basis of traditional swallowing training can improve the swallowing func- tion of post-stroke dysphagia patients, and NMES on suprahyoid muscles can further induce an increase in anterior hyoid excursion.