中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2015年
5期
348-352
,共5页
高婧慧%王强%李明%孟萍萍%张子青
高婧慧%王彊%李明%孟萍萍%張子青
고청혜%왕강%리명%맹평평%장자청
脑卒中%神经肌肉电刺激%吞咽障碍%电视X线透视吞咽功能检查%舌骨喉复合体动度
腦卒中%神經肌肉電刺激%吞嚥障礙%電視X線透視吞嚥功能檢查%舌骨喉複閤體動度
뇌졸중%신경기육전자격%탄인장애%전시X선투시탄인공능검사%설골후복합체동도
Stroke%Neuromuscular electrical stimulation%Dysphagia%Video fluoroscopic swallowing study%Hyolaryngeal structural movement
目的 观察神经肌肉电刺激(NMES)治疗脑卒中后吞咽障碍的临床疗效,对比分析不同部位电刺激对患者舌骨喉复合体动度的影响.方法 采用随机数字表法将30例脑卒中后吞咽障碍患者分为治疗A组、治疗B组及对照组.3组患者均给予常规吞咽训练、药物治疗及一般康复治疗,治疗A组在此基础上辅以舌骨上、下区神经肌肉电刺激,治疗B组则辅以单纯舌骨上区神经肌肉电刺激.分别于治疗前、治疗2周后对各组患者进行电视X线透视吞咽功能检查,并测量吞咽半流质食物时其舌骨及甲状软骨向上、向前移动距离;同时采用洼田饮水试验、才藤分级、吞咽障碍结局与严重度量表(DOSS)对各组患者疗效进行评定.结果 3组患者治疗后其洼田饮水试验分级、才藤分级、DOSS量表评分均较治疗前明显改善(P<0.05);治疗A组及治疗B组洼田分级[分别为(2.40±1.26)级和(2.10±0.99)级]、才藤分级[分别为(5.30±1.89)级和(5.20±1.69)级]、DOSS量表评分[分别为(5.20±1.40)分和(5.10±1.45)分]均显著优于对照组(P<0.05),两电刺激组患者治疗后上述疗效指标组间差异均无统计学意义(P>0.05).治疗B组患者治疗后在吞咽半流质食物时其舌骨前移距离[(12.15±7.59)mm]较治疗前及治疗A组、对照组均明显增大(P<0.05).结论 在常规吞咽训练基础上辅以神经肌肉电刺激可显著改善脑卒中后吞咽障碍患者吞咽功能;将电极片放置在舌骨上区或舌骨上、下区刺激时其疗效间无显著差异,但单纯舌骨上区电刺激可进一步改善脑卒中患者吞咽时舌骨前移距离.
目的 觀察神經肌肉電刺激(NMES)治療腦卒中後吞嚥障礙的臨床療效,對比分析不同部位電刺激對患者舌骨喉複閤體動度的影響.方法 採用隨機數字錶法將30例腦卒中後吞嚥障礙患者分為治療A組、治療B組及對照組.3組患者均給予常規吞嚥訓練、藥物治療及一般康複治療,治療A組在此基礎上輔以舌骨上、下區神經肌肉電刺激,治療B組則輔以單純舌骨上區神經肌肉電刺激.分彆于治療前、治療2週後對各組患者進行電視X線透視吞嚥功能檢查,併測量吞嚥半流質食物時其舌骨及甲狀軟骨嚮上、嚮前移動距離;同時採用窪田飲水試驗、纔籐分級、吞嚥障礙結跼與嚴重度量錶(DOSS)對各組患者療效進行評定.結果 3組患者治療後其窪田飲水試驗分級、纔籐分級、DOSS量錶評分均較治療前明顯改善(P<0.05);治療A組及治療B組窪田分級[分彆為(2.40±1.26)級和(2.10±0.99)級]、纔籐分級[分彆為(5.30±1.89)級和(5.20±1.69)級]、DOSS量錶評分[分彆為(5.20±1.40)分和(5.10±1.45)分]均顯著優于對照組(P<0.05),兩電刺激組患者治療後上述療效指標組間差異均無統計學意義(P>0.05).治療B組患者治療後在吞嚥半流質食物時其舌骨前移距離[(12.15±7.59)mm]較治療前及治療A組、對照組均明顯增大(P<0.05).結論 在常規吞嚥訓練基礎上輔以神經肌肉電刺激可顯著改善腦卒中後吞嚥障礙患者吞嚥功能;將電極片放置在舌骨上區或舌骨上、下區刺激時其療效間無顯著差異,但單純舌骨上區電刺激可進一步改善腦卒中患者吞嚥時舌骨前移距離.
목적 관찰신경기육전자격(NMES)치료뇌졸중후탄인장애적림상료효,대비분석불동부위전자격대환자설골후복합체동도적영향.방법 채용수궤수자표법장30례뇌졸중후탄인장애환자분위치료A조、치료B조급대조조.3조환자균급여상규탄인훈련、약물치료급일반강복치료,치료A조재차기출상보이설골상、하구신경기육전자격,치료B조칙보이단순설골상구신경기육전자격.분별우치료전、치료2주후대각조환자진행전시X선투시탄인공능검사,병측량탄인반류질식물시기설골급갑상연골향상、향전이동거리;동시채용와전음수시험、재등분급、탄인장애결국여엄중도량표(DOSS)대각조환자료효진행평정.결과 3조환자치료후기와전음수시험분급、재등분급、DOSS량표평분균교치료전명현개선(P<0.05);치료A조급치료B조와전분급[분별위(2.40±1.26)급화(2.10±0.99)급]、재등분급[분별위(5.30±1.89)급화(5.20±1.69)급]、DOSS량표평분[분별위(5.20±1.40)분화(5.10±1.45)분]균현저우우대조조(P<0.05),량전자격조환자치료후상술료효지표조간차이균무통계학의의(P>0.05).치료B조환자치료후재탄인반류질식물시기설골전이거리[(12.15±7.59)mm]교치료전급치료A조、대조조균명현증대(P<0.05).결론 재상규탄인훈련기출상보이신경기육전자격가현저개선뇌졸중후탄인장애환자탄인공능;장전겁편방치재설골상구혹설골상、하구자격시기료효간무현저차이,단단순설골상구전자격가진일보개선뇌졸중환자탄인시설골전이거리.
Objective To explore the effect of neuromuscular electrical stimulation(NMES) on hyolaryngeal structural movement in post-stroke dysphagia.Methods Thirty patients with post-stroke dysphagia were randomly divided into 3 groups (n =10) namely group A,group B and group C.On the basis of routine swallowing training,medication and rehabiliation given to group C,group A was provided with VitalStim therapy on both suprahyoid and infrahyoid muscles,while group B was only on suprahyoid muscles lasting 2 weeks.Before and after treatment,the Video Fluoroscopy Swallowing Study (VFSS) was carried out and the upward and forward displacement distances of the hyoid and thyroid cartilage when swallowing pap were measured.Moreover,water swallow test,dysphagia severity scale and DOSS scores were used to assess the swallowing function.Results After 2 weeks' treatment,the water drinking test score,dysphagia severity scale and DOSS scores increased significantly in all groups than before treatment.The water drinking test score of group A (2.40 ± 1.26) and group B (2.10 ± 0.99),dysphagia severity scale of group A (5.30 ± 1.89) and group B(5.20 ± 1.69),as well as the DOSS level of group A (5.20 ± 1.40) and group B (5.10 ± 1.45) were significantly better than the control group.However,no significant difference was observed in all measurements between group A and group B.The group B revealed a significantly increase in anterior hyoid excursion distance of (12.15 ± 7.59) mm,much bigger than that before treatment and that of group A and B after treatment.Conclusion NMES on the basis of traditional swallowing training can improve the swallowing function of post-stroke dysphagia patients,and NMES on suprahyoid muscles can further induce an increase in anterior hyoid excursion.