神经肌肉电刺激联合口腔感觉训练对重症病毒性脑炎合并吞咽障碍患儿的康复效果

Rehabilitation effect of neuromuscular electrical stimulation combined with oral sensory training on children with severe viral encephalitis with swallowing disorder

目的探讨神经肌肉电刺激(NMES)联合口腔感觉训练对重症病毒性脑炎(SVE)合并吞咽障碍患儿的康复效果、吞咽功能、神经功能、营养状况的影响。方法选择河北省儿童医院2021-01—2023-03收治的SVE合并吞咽障碍患儿108例。随机数字表法分为口腔感觉训练组和NMES联合组各54例。2组患者均进行抗病毒、降颅内压、去高热、控制惊厥、保护脑神经等对症支持治疗。口腔感觉训练组给予口腔感觉运动训练,NMES联合组在口腔感觉训练基础上进行NMES康复治疗。比较2组患者康复效果、吞咽功能[吞咽障碍调查量表(DDS)]、神经功能指标[血清脑源性的神经营养因子(BDNF)、神经元特异性的烯醇化酶(NSE)水平]、营养状况[主观的综合性营养评分量表(SGA)]、生活质量[吞咽障碍特异性生存质量量表(SWAL-QOL)]。结果康复治疗4周后,NMES联合组康复总有效率为92.59%,高于口腔感觉训练组的72.22%(P<0.05);NMES联合组口腔期、咽期、食管期DDS评分、SGA评分、SWAL-QOL评分、血清BDNF水平明显高于口腔感觉训练组,血清NSE水平低于口腔感觉训练组(P<0.05)。结论NMES联合口腔感觉训练用于SVE合并吞咽障碍患儿的康复治疗,可有效提升康复效果,进一步改善吞咽功能和神经功能,改善患儿的营养不良状况,提升患儿生活质量。

Objective To investigate the effect of neuromuscular electrical stimulation(NMES)combined with oral sensory training on the rehabilitation,swallowing function,nerve function and nutritional status of children with severe viral encephalitis(SVE)complicated with dysphagia.Methods Totally 108 children with SVE complicated with dysphagia in Hebei Provincial Children’s Hospital from January 2021 to March 2023 were selected and divided into oral sensory training group and NMES combined group by random number table method,54 cases in each group.Both groups received symptomatic support treatment such as anti-virus,reducing intracranial pressure,removing hyperthermia,controlling convulsion and protecting cerebral nerves.Oral sensory training group received oral sensory motor training,and NMES combined group received NMES rehabilitation therapy on the basis of oral sensory training.The rehabilitation effect,swallowing function(dysphagia disorder Survey scale(DDS)),neurological function indexes(serum levels of brain-derived neurotrophic factor(BDNF)and neuron-specific enolase(NSE)),nutritional status(subjective global assessment(SGA))and quality of life(swallowing-related quality of life(SWAL-QOL))were compared between theoral sensory training group and NMES combined group.Results After 4 weeks of rehabilitation treatment,the total effective rate of NMES combined group was 92.59%,which was higher than that of oral sensory training group 72.22%(P<0.05).The DDS scores in oral,pharyngeal and esophageal stages,SGA score,SWAL-QOL score and serum level of BDNF in NMES combined group were significantly higher than those in oral sensory training group,and the serum level of NSE was lower than that in oral sensory training group(P<0.05).Conclusion NMES combined with oral sensory training for the rehabilitation of children with SVE complicated with swallowing disorder can effectively improve the rehabilitation effect,further improve the swallowing function and neurological function,improve the malnutrition of children,and improve the quality of life of children with SVE.