舌压抗阻训练联合NMES在卒中后吞咽障碍患者中的应用

Application of tongue pressure resistance training combined with NMES in patients with dysphagia after stroke

目的探讨舌压抗阻训练联合神经肌肉电刺激(NMES)在卒中后吞咽障碍患者中的应用效果,并分析对功能性经口摄食量表(FOIS)评分、诱发电位、神经营养因子及并发症的影响。方法选取2022年1月至2023年3月就诊于湖南省人民医院/湖南师范大学附属第一医院的99例卒中后吞咽障碍患者作为研究对象,采用随机数字表法将分为联合组、对照A组、对照B组,每组33例。对照A组采取舌压抗阻训练,对照B组采取NMES,联合组采取舌压抗阻训练联合NMES,干预时间均为4周。观察并比较3组临床疗效、干预前后洼田饮水试验评分、FOIS评分、清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TRF)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)、胰岛素样生长因子-1(IGF-1)水平及并发症情况。结果联合组总有效率(90.91%)高于对照A组(66.67%)、对照B组(69.70%),差异均有统计学意义(P<0.05)。重复测量方差分析结果显示,3组洼田饮水试验、FOIS评分均存在时间、组间、交互效应(P<0.05)。单因素重复测量方差分析结果显示,干预2周、4周后,3组洼田饮水试验评分均低于干预前,FOIS评分均高于干预前,差异均有统计学意义(P<0.05)。多变量方差分析结果显示,干预前,3组洼田饮水试验、FOIS评分比较,差异均无统计学意义(P>0.05);干预2周、4周后,联合组洼田饮水试验评分均低于对照A组、对照B组,FOIS评分高于对照A组、对照B组,差异均有统计学意义(P<0.05)。重复测量方差分析结果显示,3组血清ALB、PA、TRF水平均存在时间、组间、交互效应(P<0.05)。单因素重复测量方差分析结果显示,干预2周、4周后,3组血清ALB、PA、TRF水平均高于干预前,差异均有统计学意义(P<0.05)。多变量方差分析结果显示,干预前,3组血清ALB、PA、TRF水平比较,差异均无统计学意义(P>0.05)。干预2周、4周后,联合组血清ALB、PA、TRF水平高于对照A组、对照B组,差异均有统计学意义(P<0.05)。重复测量方差分析结果显示,3组血清BDNF、NGF、IGF-1水平均存在时间、组间、交互效应(P<0.05)。单因素重复测量方差分析结果显示,干预4周后,联合组、对照B组血清BDNF、NGF、IGF-1水平均高于干预前,差异均有统计学意义(P<0.05)。多变量方差分析结果显示,干预前,3组血清BDNF、NGF、IGF-1水平比较,差异均无统计学意义(P>0.05);干预2周、4周后,联合组、对照B组血清BDNF、NGF、IGF-1水平高于对照A组,差异均有统计学意义(P<0.05)。联合组并发症总发生率(6.06%)低于对照A组(30.30%)、对照B组(27.27%),差异均有统计学意义(P<0.05)。结论舌压抗阻训练联合NMES治疗卒中后吞咽障碍患者效果可靠,可有效调控神经营养因子,促进神经功能修复,从而改善吞咽障碍,增强机体营养状态,且安全性高。

Objective To explore the application effect of tongue pressure resistance training combined with neuromuscular electrical stimulation(NMES)in patients with post-stroke dysphagia,and to analyze the effects on Functional Oral Intake Scale(FOIS)score,evoked potentials,neurotrophic factors and complications.Methods A total of 99 patients with post-stroke dysphagia who were treated in Hunan Provincial People′s Hospital/the First Affiliated Hospital of Hunan Normal University from January 2022 to March 2023 were selected as the research objects.They were divided into combined group,control group A and control group B by random number table method,with 33 cases in each group.The control group A was given tongue pressure resistance training,the control group B was given NMES,and the combined group was given tongue pressure resistance training combined with NMES.The intervention time was 4 weeks.The clinical efficacy,water swallow test,FOIS score,albumin(ALB),prealbumin(PA),transferrin(TRF),brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),insulin-like growth factor-1(IGF-1)levels and its complications before and after intervention were observed and compared among the three groups.Results The total effective rate of the combined group(90.91%)was higher than that of the control group A(66.67%)and the control group B(69.70%),and the differences were statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time,inter-group,and interaction effects in the WST and FOIS scores of the three groups(P<0.05).The results of one-way repeated measures analysis of variance showed that after 2 and 4 weeks of intervention,the scores of Kubota drinking water test in the three groups were lower than those before intervention,and the FOIS scores were higher than those before intervention,and the differences were statistically significant(P<0.05).The results of multivariate analysis of variance showed that there were no statistically significant differences in the scores of Kubota water swallowing test and FOIS among the three groups before intervention(P>0.05).After 2 and 4 weeks of intervention,the scores of Kubota drinking water test in the combined group were lower than those in the control group A and the control group B,and the FOIS scores were higher than those in the control group A and the control group B,and the differences were statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time,inter-group and interaction effects on serum ALB,PA and TRF levels in the three groups(P<0.05).The results of one-way repeated measures analysis of variance showed that after 2 and 4 weeks of intervention,the levels of serum ALB,PA and TRF in the three groups were higher than those before intervention,and the differences were statistically significant(P<0.05).Multivariate analysis of variance showed that there were no statistically significant differences in serum ALB,PA and TRF levels among the three groups before intervention(P>0.05).After 2 and 4 weeks of intervention,the levels of serum ALB,PA and TRF in the combined group were higher than those in the control group A and the control group B,and the differences were statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time,inter-group and interaction effects on serum BDNF,NGF and IGF-1 levels in the three groups(P<0.05).The results of one-way repeated measures analysis of variance showed that after 4 weeks of intervention,the serum levels of BDNF,NGF and IGF-1 in combination group and control group B were higher than those before intervention,and the differences were statistically significant(P<0.05).Multivariate analysis of variance showed that there were no statistically significant differences in serum BDNF,NGF and IGF-1 levels among the three groups before intervention(P>0.05).After 2 and 4 weeks of intervention,the serum levels of BDNF,NGF and IGF-1 in the combined group and the control group B were higher than those in the control group A,and the differences were statistically significant(P<0.05).The total incidence of complications in the combined group(6.06%)was lower than that in the control group A(30.30%)and the control group B(27.27%),and the difference was statistically significant(P<0.05).Conclusion Tongue pressure resistance training combined with NMES is reliable in the treatment of patients with dysphagia after stroke,which can effectively regulate neurotrophic factors,promote the repair of nerve function,thereby improving dysphagia and enhancing the nutritional status of the body,with high safety.