摄食训练结合神经肌肉电刺激治疗脑卒中后吞咽障碍

The effect of feeding training combined with neuromuscular electrical stimulation on poststroke dysphagia patients

目的探讨基于改良容积粘度测试评估下的摄食训练联合神经肌肉电刺激(NMES)治疗脑卒中后吞咽障碍(DAS)的疗效。方法回顾性分析浙江省东阳市人民医院2021年1~12月脑卒中后吞咽障碍患者63例的临床资料,均接受常规吞咽训练,根据治疗方案不同分为摄食训练组、NMES组和联合组,每组21例。摄食训练组接受改良容积粘度测试评估下的摄食训练,即将液体分为低稠、中稠和高稠,每种稠度以3mL、5mL、10mL次序测试,遵循中稠一低稠→高稠的测试顺序。NMES组用VitalStim神经肌肉电刺激仪在颈前正中线两侧、颏下和舌骨上部放置电极片,前后各4片,在吞咽恢复模式下将电流强度由0mA逐步增大,通常在6.3~13.2mA,1次/d,30min/次,连续治疗6周;联合组结合以上两组方法进行治疗。结果(1)临床疗效。三组总有效率比较差异具有统计学意义(χ^(2)=6.705,P=0.004),其中联合组总有效率高于摄食训练组和NMES组(P<0.05);(2)吞咽功能。治疗后,三组洼田饮水试验与SSA评分较治疗前降低,其中以联合组改善最明显,优于摄食训练组和NMES组(P<0.05),摄食训练组和NMES组比较差异无统计学意义(P>0.05);(3)生活质量。治疗后,三组SWAL-QOL评分差异具有统计学意义(F=4.533,P=0.015),且联合组优于摄食训练组和NMES组(P<0.05),摄食训练组与NMES组比较差异无统计学意义(P>0.05),各组SWAL-QOL评分较治疗前均有改善(P<0.01);(4)并发症。三组吸入性肺炎、误吸、低蛋白血症发生率比较差异无统计学意义(P>0.05)。结论基于改良容积粘度测试评估下的摄食训练结合神经肌肉电刺激治疗脑卒中后吞咽障碍疗效显著,可提高吞咽功能,保证营养吸收,提高生活质量,且干预具有较高的安全性。

Objective To explore the effect of feeding training combined with neuromuscular electrical stimulation(NMES)in the treatment of post-stroke dysphagia(DAS)based on improved volumetric viscosity testing evaluation.Method A retrospective analysis was conducted on the clinical data of 63 patients with post-stroke dysphagia at Dongyang People's Hospital in Zhejiang Province from January to December 2021.All patients received routine swallowing training and were divided into feeding training group,MES group,and combination group according to different treatment plans,with 21 cases in each group.The feeding training group received feeding training evaluated under the modified volumetric viscosity test,which divided the liquid into low viscosity,medium viscosity,and high viscosity.Each viscosity was tested in the order of 3mL,5mL,and 10mL,following the sequence of medium viscosity,low viscosity,and high viscosity.The NMES group used VitalStim neuromuscular electrical stimulators to place electrode pads on both sides of the midline of the neck,under the chin,and on the upper part of the hyoid bone,with 4 pads placed on each side.In swallowing recovery mode,the current intensity was gradually increased from OmA,usually between 6.3-13.2mA,once a day,every 30 minutes,for 6 consecutive weeks of treatment;Combine the above two methods for treatment.Results(1)Clinical efficacy.The difference in total effective rate among the three groups was statistically significant(χ^(2)=6.705,P=-0.004),with the combined group having a higher total effective rate than the feeding training group and NMES group(P<0.05);(2)Swallowing function.After treatment,the three groups of Wada drinking water test and SSA scores decreased compared to before treatment,with the combination group showing the most significant improvement,which was better than the feeding training group and NMES group(P<0.05).There was no statistically significant difference between the feeding training group and NMES group(P>0.05);(3)Quality of life.After treatment,there was a statistically significant difference in SWAL-QOL scores among the three groups(F=4.533,P=0.015),and the combination group was superior to the feeding training group and NMES group(P<0.05).There was no statistically significant difference between the feeding training group and NMES group(P>0.05),and SWAL-QOL scores in all groups improved compared to before treatment(P<0.01);(4)Complications.There was no statistically significant differencein the incidence of aspiration pneumonia,aspiration,and hypoalbuminemia among the three groups(P>0.05).Conclusion The combination of feeding training and neuromuscular electrical stimulation based on improved volumetric viscosity testing has a significant therapeutic effect on post-stroke swallowing disorders.It can improve swallowing function,ensure nutrient absorption,improve quality of life,and the intervention has high safety.