呼吸训练与神经肌肉电刺激治疗急性脑卒中后吞咽功能障碍的效果对比

Comparative effects of neuromuscular electrical stimulation and respiratory muscle training in post-stroke dysphagia

目的探讨早期开展呼吸训练与神经肌肉电刺激(NMES)治疗对脑卒中后吞咽功能障碍的临床效果。方法选取2016年10月~2018年1月我院收治的46例脑卒中后吞咽功能障碍的患者作为研究对象,按照随机数字表法分为对照组(16例)、呼吸训练治疗组(15例)和NMES治疗组(15例)。对照组患者接受常规康复训练,呼吸训练治疗组在常规康复训练的基础上再配合呼吸训练,NMES治疗组在常规康复训练的基础上再配合神经肌肉电刺激治疗,治疗4周。治疗前后均采用洼田饮水试验和吞咽筛查量表进行评定,比较各组的临床效果。结果治疗后NMES治疗组的洼田饮水试验显效率(73.3%)高于呼吸训练治疗组(60.0%),差异有统计学意义(P<0.05);治疗后三组患者的EAT-10评分均降低,NMES治疗组经治疗后EAT-10评分低于呼吸训练治疗组和对照组,差异有统计学意义(P<0.05)。结论神经肌肉电刺激联合吞咽训练的综合康复措施能明显提高吞咽功能障碍的治疗效果。

Objective To observe the effects of comprehensive treatments of neuromuscular electrical stimulation（NMES） and respiratory muscle training on the swallowing function in post-stroke dysphagia. Methods A total of forty six patients with dysphagia after stroke treated in our hospital from October 2016 to January 2018 were selected as the subjects, and divided into control group（16 cases）, respiratory training treatment group（15 cases） and NMES treatment group（15 cases） by random number table method. The control group received conventional swallowing training, while the respiratory training treatment group received breathing training and NMES group received neuromuscular electrical stimulation treatment on basis of the conventional swallowing training, they were treated for 4 weeks. Before and after treatment, the Kubota drinking water test（KDWT） and the Chinese eating assessment tool（EAT-10） were assessed, and the clinical effects were compared. Results The effectiveness rate of KDWT in the NMES treatment group（73.3%） was higher than that in the respiratory training group（60.0%）, the difference was statistically significant（P〈0.05）. After treatments, the EAT-10 scores were decreaced in the three groups, and the EAT-10 score in the NMES treatment group was significant lower than that in the respiratory training group and the control group, the differences were statistically significant（P〈0.05）. Conclusion NMES treatment combined with swallowing rehabilitation training is superior for improving the swallowing function of post-stroke dysphagia patients.