颈前部表面电刺激对食管上括约肌功能的即时影响

Treating dysphagia with surface neuromuscular electrical stimulation of the neck

目的通过高分辨率固态测压方法观察健康人颈前区不同部位组合电刺激对食管上括约肌(UES)功能的瞬时效应,并探讨其生物力学机制。方法共招募17例健康受试者,每位受试者依次接受假刺激(SS)、颈前区舌骨上下同步刺激(SIHS)、舌骨上刺激(SHS)及舌骨下刺激(IHS)四种形式刺激,脉冲频率80 Hz,电刺激强度以最大可耐受为限。借助高分辨率固态测压系统(HRM)采集4种不同刺激状态下受试者吞咽时和非吞咽时其UES功能的瞬时变化。统计学方法采用单因素重复测量的方差分析。结果与假刺激比较,电刺激后受试者UES松弛持续时间明显缩短(SIHS刺激时P值=0.036;SHS刺激时P值=0.023;IHS刺激时P值=0.020),差异具有统计学意义。入选受试者颈前区经不同模式电刺激后其UES松弛残余压均有上升趋势,以HIS刺激时上升幅度较明显,但与假刺激后相应指标比较,差异均无统计学意义(P>0.05)。与假刺激比较,受试者颈前区SIHS刺激时其UES静息压明显升高(P=0.019),而单独舌骨上或舌骨下电刺激能使UES静息压稍上升,但差异无统计学意义(SHS刺激时P值=0.220,IHS刺激时P值=0.233)。结论正常人颈前区NMES可影响其食管UES功能状态,最大可耐受强度NMES反而缩短吞咽时UES开放持续时间,并未降低UES松弛残余压,不利于UES开放,建议颈前区电刺激时采用感觉阈强度。

Objective To explore the effect of applying surface neuromuscular electrical stimulation (NMES) on the functioning of the upper esophageal sphincter (UES) using the high-resolution solid-state manometry. Methods Seventeen healthy volunteers were selected and given sham stimulation (SS), superior and inferior hyoid stimulation (SIHS), superior hyoid stimulation (SHS) or inferior hyoid stimulation (IHS) at a frequency of 80 Hz and the maximum tolerated level before swallowing. Any changes in the kinematics or biomechanics during swallowing and at rest were recorded using high-resolution solid-state manometry. One-factor repeated analysis of the measurement variance was used. Results A significant decrease in the duration of UES relaxation was observed in response to the electrical stimulation (compared with the sham stimulation). The UES′s residual pressure showed a rising trend during electrical stimulation, especially in response to IHS, but the difference compared with SS was not significant. The UES′s resting pressure during SIHS increased significantly compared with SS, but there was no significant difference between SHS and IHS in this respect. Conclusions Surface neuromuscular electrical stimulation applied to the neck can immediately change the functioning of the UES. NMES at the maximum tolerated intensity can reduce the duration of UES relaxation, which is important for dysphagia therapy and research.