CAJ | 학술논문

目的探讨神经肌肉电刺激对脑卒中后吞咽障碍的临床疗效.方法将急性脑卒中后吞咽障碍患者98例按随机数字表法分为神经肌肉电刺激(NMES)组(38例)、康复训练组(30例)和对照组(30例),对照组给予药物治疗,NMES组在对照组治疗方案的基础上给予神经肌肉电刺激疗法,康复训练组在对照组治疗方案的基础上进行吞咽康复训练.3组患者均于治疗前和治疗3周后(治疗后)采用吞咽障碍程度评分评定疗效,同时观察并发症和不良反应,并于治疗3个月后随访胃管的留置率.结果治疗后,NMES组的吞咽障碍程度评分为(7.74±1.39)分,康复训练组为(6.73±2.13)分,与组内治疗前[分别为(5.39±1.64)分和(5.57±1.70)分]和对照组治疗后的(5.50±1.94)分比较,差异均有统计学意义(P＜0.05),且治疗后,NMES组的吞咽障碍程度评分显著高于康复训练组,差异有统计学意义(P＜0.05).治疗后,NMES组吸人性肺炎发病率为21.05％,低于康复训练组的43.33％和对照组的56.67％,差异均有统计学意义(P＜0.05)；3组营养不良发生率组间比较,差异无统计学意义(P＞0.05).治疗3个月后,NMES组的胃管留置率为10.53％,显著低于对照组的36.67％ (P ＜0.05),而与康复训练组的16.67％比较,差异无统计学意义(P＞0.05).结论神经肌肉电刺激能有效地改善急性卒中后的吞咽障碍,减少误吸的发生,且短期疗效优于吞咽康复训练,但远期疗效与康复训练结果相当.
목적 탐토신경기육전자격대뇌졸중후탄인장애적림상료효.방법 장급성뇌졸중후탄인장애환자98례안수궤수자표법분위신경기육전자격(NMES)조(38례)、강복훈련조(30례)화대조조(30례),대조조급여약물치료,NMES조재대조조치료방안적기출상급여신경기육전자격요법,강복훈련조재대조조치료방안적기출상진행탄인강복훈련.3조환자균우치료전화치료3주후(치료후)채용탄인장애정도평분평정료효,동시관찰병발증화불량반응,병우치료3개월후수방위관적류치솔.결과 치료후,NMES조적탄인장애정도평분위(7.74±1.39)분,강복훈련조위(6.73±2.13)분,여조내치료전[분별위(5.39±1.64)분화(5.57±1.70)분]화대조조치료후적(5.50±1.94)분비교,차이균유통계학의의(P＜0.05),차치료후,NMES조적탄인장애정도평분현저고우강복훈련조,차이유통계학의의(P＜0.05).치료후,NMES조흡인성폐염발병솔위21.05％,저우강복훈련조적43.33％화대조조적56.67％,차이균유통계학의의(P＜0.05)；3조영양불량발생솔조간비교,차이무통계학의의(P＞0.05).치료3개월후,NMES조적위관류치솔위10.53％,현저저우대조조적36.67％ (P ＜0.05),이여강복훈련조적16.67％비교,차이무통계학의의(P＞0.05).결론 신경기육전자격능유효지개선급성졸중후적탄인장애,감소오흡적발생,차단기료효우우탄인강복훈련,단원기료효여강복훈련결과상당.
Objective To investigate the clinical therapeutic effects of neuromuscular electric stimulation (NMES) on patients with swallowing disorders after stroke. Methods A total of 98 patients with a swallowing disorder after stroke were randomly divided into an NMES group (38 cases),a rehabilitation group (30 cases) and a control group (30 cases).In the control group the patients were treated with medication only; the in rehabilitation group they were treated with medication and swallowing rehabilitation training; in the NMES group they were treated with medication and NMES.The treatments lasted for 3 weeks in all groups.The swallowing function of patients in each group were observed and assessed with dysphagia scoring pre-and post-treatment.Complications of the swallowing disorders,side effects of treatment and the stomach tube leaving rate were observed. Results After treatment,the dysphagia scores of patients in the NMES and rehabilitation groups both increased,but the average scores in the NMES group were significantly higher than in the rehabilitation and control groups.The difference in therapeutic effect between the three groups was statistically significant.After treatment,the incidence of aspiration pneumonia in the NMES group was significantly lower than that in the control and rehabilitation groups.The average stomach tube leaving rate in the NMES group was significantly lower than that in the control group,but there was no significant difference in stomach tube leaving rates between the rehabilitation group and the NMES group.There was no significant difference among the three groups in malnutrition.No side effect was observed in any group. Conclusions NMES could alleviate post-stroke dysphagia and decrease the incidence of aspiration.The short-term therapeutic effect of NMES was better than that of swallowing rehabilitation training,but the long-term therapeutic effects were about the same in the two groups.