神经肌肉电刺激对卒中后吞咽障碍治疗作用的研究

doi:10.3969/j.issn.1673-5765.2017.03.003

摘要/Abstract

摘要：

目的应用视频透视吞咽检查（video fluoroscopy swallowing study，VFSS）方法从吞咽运动学变化方面研究神经肌肉电刺激（neuromuscular electrical stimulation，NMES）对卒中患者吞咽障碍的治疗作用。方法将卒中后吞咽障碍患者随机分为研究组和对照组，研究组给予NMES治疗，对照组给予假刺激，治疗均为每次20 mi n，5次/周，持续4周。同时所有患者均进行吞咽常规训练。治疗前后均行 VFSS，获取3 ml液态钡食、10 ml液态钡食、半固体钡食及固体钡食4种食团吞咽的Rosenbek渗透-误吸量表（penetration-aspiration scale，PAS）评分、咽传递时间（pharyngeal transit time，PTT）、咽延迟时间（pharyngeal delayed time，PDT）、舌骨向前最大幅度、舌骨向上运动最大幅度、喉向前最大幅度及喉向上运动最大幅度。对比两组治疗前后PAS量表评分及上述吞咽运动学参数的变化。结果研究共纳入43例患者，其中研究组23例，对照组20例。治疗后，两组患者4种食团吞咽时PAS评分均较治疗前下降，PTT、PDT较治疗前缩短（均P＜0.05）。治疗前和治疗后，研究组在各食团吞咽时 PAS评分及PTT、PDT较对照组差异均无显著性。治疗前，两组间舌骨向前、向上运动，喉向前、向上运动的最大幅度差异均无显著性；治疗后，研究组食团吞咽时舌骨向上运动、喉向上运动的最大幅度均较对照组显著增大（均P＜0.05），但两组舌骨向前、喉向前运动差异无显著性。结论 NMES和常规吞咽康复训练均可改善卒中患者的吞咽功能。NMES更能提高喉-舌骨复合体的向上运动。

were obtained. The differences between two groups before and after treatment were identified respectively. Results A total of 43 patients were enrolled into study including 23 cases in study group and 20 cases in control group. After treatments, the scores of PAS of swallowing of 4 kinds of food in both groups were significantly reduced, and PDT and PTT were shorter compared with those before treatment (All P <0.05). There were no significant differences between two groups in the scores of PAS, PTT and PDT before and after treatment. Before treatment, there was no significance in difference in forward laryngeal movement, upward laryngeal movement, forward hyoid movement and upward hyoid movement between two groups. After treatment, upward laryngeal movement and upward of hyoid movement of study group were significantly increased compared with those of the control group (All P <0.05), however, there were no significant differences in forward laryngeal movement and forward hyoid movement between two groups. Conclusion NMES and traditional swallowing therapy can improve the swallowing function of stroke patients. The application of NMES could improve the upward movement of hyolaryngeal complex better. 【Key Words】 Stroke

文章导读： 应用视频X线检查吞咽时气道侵入及运动学参数对卒中后吞咽障碍患者的治疗效果进行观察，显示神经肌肉电刺激和常规吞咽康复训练均可改善卒中患者的吞咽功能，而且神经肌肉电刺激更能提高喉-舌骨复合体的向上运动。

关键词: 卒中; 吞咽障碍; 神经肌肉电刺激

Abstract:

Objective To clarity the effects of neuromuscular electrical stimulation (NMES) on swallowing function of post-stroke patients from kinematic research of swallowing by video fluoroscopy swallowing study (VFSS). Methods Patients with dysphagia were recruited and randomly allocated to the study group and the control group. VFSS was performed before treatments. Patients in the study group received real NMES, and patients in the control group received sham NMES. Different interventions were applied for 20 min per time, 5 times per week, for 4 weeks. All the patients received traditional swallowing therapy at the same time. The evaluation was performed by using VFSS before and after treatment. Rosenbek Penetration-Aspiration scale (PAS) of 3 ml liquid barium food, 10 ml liquid barium food, semisolid barium food and solid barium food, pharyngeal transit time (PTT), pharyngeal delayed time (PDT), maximal extent of forward laryngeal movement and upward laryngeal movement, maximal extent of forward hyoid movement and upward hyoid movement

Key words: Stroke; Dysphagia; Neuromuscular electrical stimulation

李冰洁，张通，李芳. 神经肌肉电刺激对卒中后吞咽障碍治疗作用的研究[J]. 中国卒中杂志, 2017, 12(03): 207-213.

LI Bing-Jie, ZHANG Tong, LI Fang. Study on Effects of Neuromuscular Electrical Stimulation on Dysphagia in Post-stroke Patients[J]. Chinese Journal of Stroke, 2017, 12(03): 207-213.

参考文献

1 Takizawa C，Gemmell E，Kenworthy J，et al. A

systematic review of the prevalence of oropharyngeal

dysphagia in stroke，Parkinson's disease，Alzheimer's

disease，head injury，and pneumonia[J]. Dysphagia，

2016，31：434-341.

2 Cecconi E，Di Piero V. Dysphagia--pathophysiology，

diagnosis and treatment[J]. Front Neurol Neurosci，

2012，30：86-89.

3 Rogus-Pulia N，Robbins J. Approaches to the

rehabilitation of dysphagia in acute poststroke

patients[J]. Semin Speech Lang，2013，34：154-169.

4 Bulow M，Speyer R，Baijens L，et al. Neuro-muscular

electrical stimulation (NMES) in stroke patients with

oral and pharyngeal dysfunction[J]. Dysphagia，2008，

233：302-309.

5 Philip M，Polly S，Jo L，et al. Pharyngeal electrical

stimulation for treatment of dysphagia in subacute

stroke[J]. Stroke，2016，47：1562-1570.

6 Clark H，Lazarus C，Arvedson J. Evidence-based

systematic review：effects of neuromuscular electrical

stimulation on swallowing and neural activation[J].

Am J Speech Lang Pathol，2009，18：361-375.

7 中华神经科学会. 各类脑血管病诊断要点[J]. 中华神

经科杂志，1996，29：379-380.

8 Bingjie L，Tong Z，Xinting S，et al. Quantitative

videofluoroscopic analysis of penetration-aspiration

in post-stroke patients[J]. Neurol India，2010，58：

42-47.

9 Robbins JA，Suf it R，Rosenbek J，et a l. A

modification of the modified barium swallow[J].

Dysphagia，1987：83-86.

10 Aslam M，Michael FV. Dysphagia in the elderly[J].

Gastroenterol Hepatol，2013，9：784-795.

11 Cohen DL，Roffe C，Beavan J，et al. Post-stroke

中国卒中杂志 2017年3月第12卷第3期 213

dysphagia：A review and design considerations for

future trials[J]. Int J Stroke，2016，11：399-411.

12 Huang KL，Liu TY，Huang YC，et al. Functional

outcome in acute stroke patients with oropharyngeal

dysphagia after swallowing therapy[J]. J Stroke

Cerebrovasc Dis，2014，23：2547-2553.

13 Park JW，Oh JC，Lee HJ，et al. Effortful swallowing

training coupled with electrical stimulation leads to

an increase in hyoid elevation during swallowing[J].

Dysphagia，2009，24：296-301.

14 Christiaanse ME，Mabe B，Russell G. Neuromuscular

electrical stimulation is no more effective than

usual care for the treatment of primary dysphagia in

children[J]. Pediatr Pulmonol，2011，46：559-565.

15 Langmore SE，McCulloch TM，Krisciunas GP，et

al. Efficacy of electrical stimulation and exercise for

dysphagia in patients with head and neck cancer：A

randomized clinical trial[J]. Head Neck，2016，38：

E1221-1231.

16 Poorjavad M，Talebian Moghadam S，Nakhostin

Ansari N，et al. Surface electrical stimulation for

treating swallowing disorders after stroke：a review

of the stimulation intensity levels and the electrode

placements[J]. Stroke Res Treat，2014：918 057.

17 Park JS，Oh DH，Hwang NK，et al. Effects of

neuromuscular electrical stimulation combined with

effortful swallowing on post-stroke oropharyngeal

dysphagia：a randomised controlled trial[J]. J Oral

Rehabil，2016，43：426-434.

18 González-Fernández M，Ottenstein L，Atanelov L，et

al. Dysphagia after stroke：an overview[J]. Curr Phys

Med Rehabil Rep，2013，1：187-196.

[1]	鲁燕, 杨保荣, 黄向萍, 杨冠桂, 陈圣文, 李建荣, 曾小明. 县级医院急性缺血性卒中超时间窗经MRI筛选溶栓的病例对照研究 [J]. 中国卒中杂志, 2022, 17(12): 1321-1326.
[2]	楚悦琪, 周凯云, 王田燕, 王炯彬, 李真. 卒中后吞咽障碍应用耳穴压豆治疗效果的meta分析 [J]. 中国卒中杂志, 2022, 17(12): 1327-1334.
[3]	周甜甜, 苏文杰, 连松勇, 林友聪. 丰富环境对卒中后血管性痴呆患者认知功能的影响 [J]. 中国卒中杂志, 2022, 17(12): 1343-1349.
[4]	吴娱倩, 张玉梅, 范小伟, 王安心, 逄文斌. 运动想象-动觉治疗对缺血性卒中患者手功能康复效果的研究[J]. 中国卒中杂志, 2022, 17(12): 1366-1371.
[5]	蒋林, 李靖. 基于知识图谱分析人工智能用于卒中研究的现状及趋势 [J]. 中国卒中杂志, 2022, 17(12): 1372-1380.
[6]	梁潇, 钱海兵. 水通道蛋白4与卒中后认知障碍的关系研究进展[J]. 中国卒中杂志, 2022, 17(12): 1385-1390.
[7]	吴晓莉, 刘丽旭. 肥胖对卒中预后的影响[J]. 中国卒中杂志, 2022, 17(12): 1391-1395.
[8]	伊珞, 周宏宇, 仇鑫, 李子孝, 王拥军. 动脉粥样硬化性疾病的DNA甲基化改变[J]. 中国卒中杂志, 2022, 17(11): 1163-1170.
[9]	王誉博, 李子孝, 王拥军. 表观遗传学与缺血性卒中后氧化应激的相关性研究进展[J]. 中国卒中杂志, 2022, 17(11): 1171-1177.
[10]	闫然, 闵妍, 全柯华, 李子孝. 脑源性神经营养因子和血清素再摄取转运体编码基因甲基化与卒中预后的关系[J]. 中国卒中杂志, 2022, 17(11): 1178-1182.
[11]	崔凌云, 仇鑫, 周宏宇, 李子孝, 王拥军. DNA甲基化与2型糖尿病的相关性研究进展[J]. 中国卒中杂志, 2022, 17(11): 1183-1188.
[12]	邓宇含, 刘爽, 王子尧, 汪雨欣, 刘宝花. 基于结构化数据和机器学习模型预测普通人群卒中发病风险的系统评价和meta分析 [J]. 中国卒中杂志, 2022, 17(11): 1189-1197.
[13]	刘光亮, 韩凯月, 苏文龙, 张皓. 不同强度有氧踏车训练对不同病程缺血性卒中患者运动和心肺适能的影响 [J]. 中国卒中杂志, 2022, 17(11): 1203-1208.
[14]	孙默一, 张玉梅, 刘然, 赵依双. 不同时间康复介入对卒中患者运动功能的影响 [J]. 中国卒中杂志, 2022, 17(11): 1209-1215.
[15]	胡红梅, 杨磊, 于玲, 秦伟, 白明悦, 胡文立. 急性单发小脑小梗死的临床特征 [J]. 中国卒中杂志, 2022, 17(11): 1221-1226.