吞咽障碍患者神经肌肉电刺激治疗效果评价

Effect of neuromuscular electrical stimulation on patients with dysphagia

目的吞咽障碍可引发严重并发症,影响患者康复效果和生存质量。神经肌肉电刺激可以锻炼和加强肌肉的力量,增强神经反馈及时序性,恢复运动控制,改善患者预后。本研究探讨神经内科吞咽障碍患者行神经肌肉电刺激治疗的效果。方法选择2016-05-15-2017-05-15聊城市东昌府人民医院收治的90例神经内科吞咽障碍患者作为研究对象,根据患者临床资料进行配对设计,将患者分为研究组和对照组各45例。对照组采用常规吞咽康复训练,研究组在对照组基础上实施神经肌肉电刺激治疗。比较两组治疗前后洼田氏饮水试验分级、临床效果、Rosenbek渗漏-误吸量表(penetration-aspiration scale,PAS)评分、放射线透视下吞咽功能检查(videofluoroscopy swallowing study,VFSS)评分及舌骨喉复合体上移、前移运动速度。结果治疗后研究组Ⅰ、Ⅱ、Ⅲ、Ⅳ洼田饮水试验分级改善程度明显优于对照组,χ2=20.801,P<0.001;研究组临床有效率为95.6%,显著高于对照组的80.0%,χ2=5.075,P=0.024;研究组VFSS评分为(7.41±2.51)分,高于对照组的(4.42±1.37)分,t=7.540,P<0.001;PAS评分为(2.16±0.76)分,低于对照组的(3.87±0.85)分,t=10.815,P<0.001;研究组舌骨上移速度为(27.37±8.06)mm/s,高于对照组的(21.83±9.04)mm/s,t=3.068,P=0.001;舌骨前移速度为(32.52±7.48)mm/s,高于对照组的(19.27±7.26)mm/s,t=8.527,P<0.001;甲状软骨上移速度为(33.82±9.04)mm/s,高于对照组的(25.61±9.39)mm/s,t=4.225,P<0.001;甲状软骨前移速度为(25.15±9.38)mm/s,高于对照组的(19.39±9.26)mm/s,t=2.931,P=0.002。结论吞咽障碍患者行神经肌肉电刺激治疗可提高临床效果,改善患者吞咽功能,提高生存质量。

OBJECTIVE Dysphagia can cause serious complications,affecting the rehabilitation effect and quality of life of patients.Neuromuscular electrical stimulation can exercise and strengthen muscle strength, enhance neural feedback in a timely manner,restore motor control and improve patient prognosis.The purpose of this study is to investigate the effect of neuromuscular electrical stimulation in patients with dysphagia in department of neurology.METHODS A total of 90 cases with dysphagia admitted to Dongchangfu People's Hospital from May 15,2016 to May 15,2017 were selected as study subjects.A matching design was conducted based on the clinical data of the patients,and the patients were divided into study group and control group, with 45 cases in each group.The control group received conventional deglutition rehabilitation training.The study group was treated with neuromuscular electrical stimulation on the basis of the control group.The kubota's drinking water test grading,clinical effect,an aspiration rosenbek leakage scale (PAS) score,videofluoroscopy swallowing study(VFSS) score,hyoid laryngeal complex upward and forward speeds were compared between the two groups before and after treatment.RESULTS After treatment,the improvement degree of kubota drinking water test with Ⅰ,Ⅱ,Ⅲ,Ⅳ grade in study group was better than that in control group,χ^2=20.801 ,P=20.801.The clinical efficiency of the study group was 95.6%, which was significantly higher than that of the control group (80.0%).The VFSS score of the study group was (7.41±2.51),higher than that of the control group (4.42±1.37),t=7.540,P<0.001.PAS score (2.16±0.76) was lower than that of the control group (3.87±0.85),t=10.815,P<0.001.The speed of hyoid upward movement in the study group was (27.37±8.06) mm/s, higher than that in the control group (21.83±9.04) mm/s,t=3.068,P=0.001.The speed of hyoid forward movement was (32.52±7.48) mm/s,higher than that of the control group (19.27±7.26) mm/s,t=8.527,P<0.001.The speed of thyroid cartilage upward movement was (33.82±9.04) mm/s, higher than that of the control group (25.61 ± 9.39) mm/s,t=4.225, P<0.001.The speed of thyroid cartilage forward movement was (25.15±9.38) mm/s,higher than that of the control group (19.39±9.26) mm/s,t=2.931,P=0.002.CONCLUSION The application of neuromuscular electrical stimulation in patients with dysphagia can improve the clinical effect,the swallowing function and the quality of life of patients.