针刺联合表面肌电生物反馈疗法与Shaker训练对鼻咽癌放疗后吞咽障碍患者吞咽功能及生活质量的影响

Effects of Acupuncture Combined with Surface Electromyographic Biofeedback Therapy and Shaker Exercise on Swallowing Function and Quality of Life in Patients with Dysphasia After Radiotherapy for Nasopharyngeal Carcinoma

目的观察针刺联合表面肌电生物反馈疗法(sEMG-BFB)与Shaker训练对鼻咽癌(NPC)放疗后吞咽障碍患者吞咽功能及生活质量的影响。方法将96例NPC放疗后吞咽障碍患者随机分为对照组和治疗组,每组48例。对照组采用sEMG-BFB疗法及Shaker训练,治疗组在对照组基础上进行针刺治疗。于治疗前后通过对两组行吞咽造影检查(VFSS)及洼田饮水试验(WST)来评定吞咽功能,测定两组营养指标[前白蛋白(PA)和白蛋白(ALB)],并采用吞咽生活质量量表(SWAL-QOL)评估两组生活质量。结果两组治疗后VFSS咽通过时间较治疗前缩短(P<0.05),且治疗组短于对照组(P<0.05);两组治疗后WST分级优于治疗前(P<0.05),且治疗组优于对照组(P<0.05);两组治疗后血清PA、ALB水平及SWAL-QOL评分较治疗前升高(P<0.05),且治疗组高于对照组(P<0.05)。结论对NPC放疗后吞咽障碍患者实施针刺联合sEMG-BFB与Shaker训练干预,可明显改善患者吞咽功能及营养状况,有效提升生活质量。

Objective To observe the effects of acupuncture combined with surface electromyographic biofeedback(sEMG-BFB)therapy and Shaker exercise on the swallowing function and quality of life(QOL)in patients with dysphasia after radiotherapy for nasopharyngeal carcinoma(NPC).Method Ninety-six patients with dysphasia after radiotherapy for NPC were randomized into a control group and a treatment group,with 48 cases in each group.The control group underwent sEMG-BFB therapy and Shaker exercise,and the treatment group received additional acupuncture intervention.Before and after the treatment,video fluoroscopic swallowing study(VFSS)and water swallowing test(WST)were used to evaluate swallowing function,nutritional indicators[prealbumin(PA)and albumin(ALB)]were determined,and QOL was estimated by the swallowing-related quality of life questionnaire(SWAL-QOL).Result The VFSS showed that the pharyngeal transit time was shortened after the treatment in both groups(P<0.05)and was shorter in the treatment group than in the control group(P<0.05).The WST grading improved after the intervention in the two groups(P<0.05),and the treatment group was superior to the control group(P<0.05).The serum PA and ALB levels and the SWAL-QOL score increased after the intervention in both groups(P<0.05)and were higher in the treatment group than in the control group(P<0.05).Conclusion For patients with dysphasia after radiotherapy for NPC,acupuncture combined with sEMG-BFB and Shaker exercise can notably improve swallowing function and nutritional status and effectively enhance QOL.