吞咽神经肌肉电刺激联合舌压抗阻反馈训练对脑卒中后吞咽障碍患者的康复效果

Rehabilitation effect of swallowing neuromuscular electrical stimulation combined with tongue pressure resistance feedback training on patients with dysphagia after stroke

目的观察吞咽神经肌肉电刺激联合舌压抗阻反馈训练对脑卒中后吞咽障碍患者的康复效果。方法回顾性纳入2019-01—2023-01商丘市第一人民医院治疗的124例脑卒中后吞咽障碍患者,所有患者均进行摄食训练,对照组患者(n=62)增加吞咽神经肌肉电刺激,观察组患者(n=62)采取舌压抗阻反馈训练及吞咽神经肌肉电刺激。采用改良式钡剂吞咽障碍量表(MBSImP)评估患者的吞咽功能,使用表面肌电分析系统检测最大波幅值、吞咽时程,吞咽舌肌评估训练仪检测患者的舌压,采用电视X线透视评估舌骨喉复合体动度,对比2组临床疗效。结果干预后观察组患者口腔期、咽期MBSImP评分均低于对照组,表面肌电图最大波幅值、吞咽时程优于对照组,舌压峰值、舌压平均值均高于对照组,舌压持续时长大于对照组,组间比较均有统计学差异(P<0.05)。相较于干预前及同期对照组,干预后观察组患者舌骨上移、前移水平升高(P<0.05),而2组甲状骨上移、前移水平干预前后比较均无统计学差异(P>0.05)。观察组临床总有效率为90.32%,显著高于对照组的69.35%(P<0.05)。结论脑卒中后吞咽障碍患者采用吞咽神经肌肉电刺激联合舌压抗阻反馈训练,可有效提升吞咽功能,提高两侧颏舌骨肌、下颌舌骨肌肌力及进食能力,临床效果显著。

Objective To observe the rehabilitation effect of swallowing neuromuscular electrical stimulation combined with tongue pressure resistance feedback training on patients with dysphagia after stroke.Methods The clinical data of 124 patients with dysphagia after stroke treated in our hospital from January 2019 to January 2023 were retrospectively analyzed.All patients underwent feeding training.On the basis,62 patients in the control group received swallowing neuromuscular electrical stimulation,and 62 patients in the observation group received tongue pressure resistance feedback training on the basis of the control group.The swallowing function of the patients was evaluated by the modified barium swallow impairment profile(MBSImP),the swallowing duration and maximum amplitude were measured by the surface electromyographic analysis system,the tongue pressure was measured by the swallowing tongue muscle evaluation and training instrument,and the hyolaryngeal complex movement was evaluated by TV fluoroscopy.The clinical efficacy of the two groups was compared.Results After intervention,the oral and pharyngeal MBSImP scores in the observation group were lower than those in the control group,the maximum amplitude of surface EMG and swallowing duration were better than those in the control group,the peak value and average value of tongue pressure were higher than those in the control group,and the duration of tongue pressure was longer than that in the control group,with statistical significances(P<0.05).Compared with the control group and before the intervention,the level of hyoid upward movement and anterior movement increased in the observation group after intervention(P<0.05),while there was no statistical significance in the level of thyroid upward movement and anterior movement between the two groups before and after intervention(P>0.05).The total clinical effective rate of the observation group(90.32%)was higher than that of the control group(69.35%,P<0.05).Conclusion Swallowing neuromuscular electrical stimulation combined with tongue pressure resistance feedback training can effectively improve the swallowing function of patients with swallowing disorder after stroke,improve the muscle strength of both geniohyoid and mylohyoid muscles,and improve the eating ability,with significant clinical effects.