脑卒中吞咽障碍患者表面肌电信号与咽期活动的量化关系研究

Quantifying the relationship between surface electromyographic signals and pharyngeal swallowing event in patients with dysphagia after stroke

目的:通过观察吞咽过程中的表面肌电(sEMG)信号和吞咽造影(VFSS)时吞咽器官的结构性位移,探讨脑卒中吞咽障碍患者吞咽器官形态学变化与电生理指标的相关性。方法:选取经床旁筛查证实存在吞咽障碍的脑卒中恢复期患者21例,设为病例组,另选取健康受试者9例设为正常对照组。对所有患者进行VFSS检查,同时在同一次吞咽动作中采集颏下肌群、舌骨下肌群的sEMG信号。使用吞咽功能影像数字化采集与分析系统记录吞咽过程,对吞咽时吞咽器官活动进行量化分析。对两组受试者的肌电活动持续时间、平均振幅、激活顺序、肌电活动潜伏期以及舌骨运动潜伏期进行比较,并对病例组患者sEMG信号与舌骨喉复合体位移、食管上括约肌(UES)开放幅度进行相关性分析。结果:病例组颏下肌群及舌骨下肌群的吞咽时程大于对照组,平均振幅小于对照组(P<0.05);病例组患者sEMG颏下肌群平均振幅与舌骨位移以及UES开放幅度均未见明显相关。病例组患者中有14例表现为反向激活序列模式,有7例表现为正向激活序列模式。反向激活序列模式的患者与正向激活序列模式的患者相比,舌骨位移以及UES开放幅度均显著下降(P<0.05)。病例组患者肌电活动潜伏期以及舌骨运动潜伏期均大于对照组(P<0.05)。结论:使用sEMG同步VFSS检测方法评估吞咽功能,可作为一种精确、全面的定量评估吞咽功能的方法。

Objective:To investigate the correlation between morphological changes of swallowing organs and electrophysiological indices in patients with dysphagia after stroke by observing surface electromyography(sEMG)signals during swallowing and structural displacement of swallowing organs during videofluoroscopic swallow study(VFSS).Method:Twenty-one patients in recovery period after stroke with swallowing disorders confirmed by bedside screening were selected as the patient group,and nine healthy subjects were selected as the control group.VFSS was performed on all patients,and the sEMG signals of the submental and subhyoid muscles were collected during the same swallowing movement.The swallowing process was recorded using the videofluoroscopic images digital acquisition and analysis system to quantify the swallowing organ activity during swallowing.The duration,mean amplitude,order of activation of the sEMG activity,the latencies of sEMG signal and hyoid movement were compared between two groups.The correlation between the sEMG signal and the displacement of the hyoid bone and the upper esophageal sphincter(UES)maximum opening diameter was analysed in the patient group.Result:The swallowing duration of the submental and the subhyoid muscle in patient group was longer than that in the control group,and the mean amplitude was smaller than that in the control group(P<0.05).There is no significant correlation between the mean amplitude of submental muscles and the displacement of the hyoid bone and the UES maximum opening diameter in the patient group.Fourteen people in the patient group showed inverted muscle activation pattern and seven showed ordered muscle activation pattern.Hyoid displacement and UES maximum opening diameter were significantly reduced in patients in the inverted muscle activation pattern compared to those in ordered muscle activation pattern.The latencies of sEMG signal and hyoid movement were longer than those in the control group.Conclusion:The concurrent use of sEMG and VFSS for evaluating dysphagia can be accurate and effective diagnosis tool for the comprehensive evaluation of swallowing function.