呼吸肌训练联合肌电生物反馈训练对喉癌术后吞咽功能及吸入性肺炎的影响
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摘要
目的探讨呼吸肌训练联合肌电生物反馈训练对喉癌喉切除术后患者的吞咽功能的影响,评估该康复治疗对喉癌喉切除术后吞咽障碍患者吞咽功能训练的价值;通过有效科学数据对该患者的康复及相关治疗能否有效减少吸入性肺炎发生进行分析。方法通过将2015年1月~2018年3月在我院治疗的64例喉癌术后吞咽障碍患者随机分组,分为A、B、C三组,A组22例接受常规吞咽功能训练,B组21例接受肌电生物反馈训练联合常规吞咽功能训练,C组21例接受呼吸肌训练和肌电生物反馈训练、常规吞咽功能训练。运用表面肌电图采集舌骨上肌群肌电积分值(iEMG)及洼田饮水实验评估吞咽障碍的疗效;采用吸入性肺炎诊断标准判断吸入性肺炎发生情况。结果在研究终点,三组患者舌骨上肌群肌电积分值均较治疗前提高(P <0.05);其中C组的提高幅度更为明显,优于B组和A组,组间差异有统计学意义(P <0.05)。在研究终点,A、B和C三组吸入性肺炎的发生率分别为30.00%、20.00%和5.00%,三组的组间差异及治疗有效率差异均有统计学意义(P <0.05)。结论呼吸肌训练联合肌电生物反馈训练可改善喉癌术后吞咽障碍患者的吞咽功能,可有效降低吸入性肺炎的发生率。
Objective To discuss the effect of the respiratory muscle training combined with the electromyography biofeedback training on the swallowing function of patients with laryngocarcinoma after operation,and to evaluate the value of the rehabilitation therapy on swallowing function training for patients with dysphagia. And to verify the rehabilitation and related treatment can effectively reduce the incidence of aspiration pneumonia through effective scientific data. Methods Sixty-four dysphagia patients with laryngocarcinoma after operation in our hospital from January 2015 to March 2018 were randomly divided into three groups. Twenty-two patients of the group A received routine swallowing training, twenty-one patients of the group B received electromyographic biofeedback training combined with the conventional swallowing training, and twenty-one patients of the group C received respiratory muscle training and electromyographic biofeedback training, routine swallowing function training. The surface electromyography was used to collect the integral value of the hyoid muscle group(iEMG) and Sumida drinking water test to evaluate the efficacy of dysphagia, and the diagnostic criteria of inhalation pneumonia was used to determine the incidence of inhalation pneumonia. Results At the end of the study, the integral value of the hyoid muscle group in the three groups was higher than that before the treatment(P < 0.05), and the increase in the group C was more obvious than that of the group B and the group A, there was significant difference between these three groups(P<0.05). At the end of the study, the incidence of inhalation pneumonia in the three groups of the A,B and C were 30.00%, 20.00% and 5.00% respectively. The total effective rate of the three groups and the difference between them were statistically significant(P < 0.05). Conclusion The respiratory muscle training combined with electromyography biofeedback training can improve the swallowing function of the patients with laryngocarcinoma after operation, and it can also reduce the incidence of inhaled pneumonia effectively.
Objective To discuss the effect of the respiratory muscle training combined with the electromyography biofeedback training on the swallowing function of patients with laryngocarcinoma after operation,and to evaluate the value of the rehabilitation therapy on swallowing function training for patients with dysphagia. And to verify the rehabilitation and related treatment can effectively reduce the incidence of aspiration pneumonia through effective scientific data. Methods Sixty-four dysphagia patients with laryngocarcinoma after operation in our hospital from January 2015 to March 2018 were randomly divided into three groups. Twenty-two patients of the group A received routine swallowing training, twenty-one patients of the group B received electromyographic biofeedback training combined with the conventional swallowing training, and twenty-one patients of the group C received respiratory muscle training and electromyographic biofeedback training, routine swallowing function training. The surface electromyography was used to collect the integral value of the hyoid muscle group(iEMG) and Sumida drinking water test to evaluate the efficacy of dysphagia, and the diagnostic criteria of inhalation pneumonia was used to determine the incidence of inhalation pneumonia. Results At the end of the study, the integral value of the hyoid muscle group in the three groups was higher than that before the treatment(P < 0.05), and the increase in the group C was more obvious than that of the group B and the group A, there was significant difference between these three groups(P<0.05). At the end of the study, the incidence of inhalation pneumonia in the three groups of the A,B and C were 30.00%, 20.00% and 5.00% respectively. The total effective rate of the three groups and the difference between them were statistically significant(P < 0.05). Conclusion The respiratory muscle training combined with electromyography biofeedback training can improve the swallowing function of the patients with laryngocarcinoma after operation, and it can also reduce the incidence of inhaled pneumonia effectively.
引文
[1]李晓丽,李建斌,李晓慧,等.手术联合放射治疗对喉癌患者甲状腺功能及营养状况的改善作用[J].海南医学,2017,28(12):2028-2030.
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[6]田野,熊高华,胡可慧,等.肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响[J].中国康复,2016,31(6):430-433.
[7]俞长君,李雪萍,林强,等.呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响[J].中华物理医学与康复杂志,2016,38(10):735-739.
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[9]姜晖,王丽萍,吉鹏,等.声门上型喉癌和下咽癌对吞咽功能影响的初步探讨[J].听力学及言语疾病杂志,2018,26(1):29-33.
[10]苏文华,阎文静,钟明华,等.神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及其表面肌电图的影响[J].中华物理医学与康复杂志,2015,37(3):183-186.
[11]董德朋,袁雷,赵扬,等.人体自由负重深蹲在稳定与非稳定条件下肌肉iEMG比较研究[J].天津体育学院学报,2017,32(2):162-168.
[12]宁璞,杨菁菁,孙铁英,等.住院老年人吸入性肺炎患病率及其危险因素分析[J].中华老年医学杂志,2017,36(4):428-432.
[13]Ward K,Seymour J,Steier J,et al.Acute ischaemic hemi-spheric stroke is associated with impairment of reflex in addition to voluntary cough[J].Eur Respir J,2010,36(6):1383-1390.
[14]张焱,王敏,傅小利,等.环状软骨上喉部分切除术后早期吞咽功能训练的临床应用[J].局解手术学杂志,2017,26(10):776-779.
[15]Messaggi-Sartor M,Guillen-SolàA,Depolo M,et al.Inspiratory and expiratory muscle training in subacute stroke:A randomized clinical trial[J].Neurology,2015,85(7):564-572.
[16]陈勇,王宝强,何潇,等.阻力呼吸器训练对肺癌放疗后患者生命质量及肺功能的影响[J].中华物理医学与康复杂志,2017,39(4):297-299.
[17]杨华,张洪宇,高茹,等.23例喉癌患者环状软骨上喉部分切除术后吞咽功能评估与康复训练[J].护理学报,2016,23(11):58-60.
[18]钟志明,田文栋,刘雄,等.环状软骨上喉部分切除术后吞咽功能评估的初步研究[J].中华耳鼻咽喉头颈外科杂志,2015,50(2):95-100.
[19]Similow T,Catala M,Rancurel G,et al.Impairment of central motor conduction to the diaphragm in stroke[J].Am J Respir Crit Care Med,1996,154(1):436-441.
[20]杨初燕,冯珍,刘玲玲.呼吸功能训练对脑卒中伴老年慢性阻塞性肺病患者吞咽功能的影响[J].中华物理医学与康复杂志,2015,37(4):266-268.
[21]Kulnik ST,Rafferty GF,Birring SS,et al.A pilotstudy of respiratory muscle training to improve cough effectiveness and reduce the incidence of pneumonia in acute stroke:Study protocol for a randomized controlled trial[J].Trials,2014,15(1):123.
[2]朱晓城,钱晓云,顾亚军,等.MGMT和EGFR蛋白在喉鳞状细胞癌中的表达及临床意义[J].山东大学耳鼻喉眼学报,2017,31(4):68-72.
[3]Tomifuji M,Araki K,Yamashita T,et al.Risk factors for dysphagia after transoral videolaryngoscopic surgery for laryngeal and pharyngeal cancer[J].Head&Neck,2016,38(2):196.
[4]Depietro JD,Rubin S,Stein DJ,et al.Laryngeal manipulation for dysphagia with muscle tension dysphonia[J].Dysphagia,2018,151(1 Suppl):1-6.
[5]杨玺,刘进,马明.深层咽肌神经刺激和表面肌电生物反馈在脑卒中后咽期吞咽障碍中的应用[J].中国康复医学杂志,2016,31(4):451-453.
[6]田野,熊高华,胡可慧,等.肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响[J].中国康复,2016,31(6):430-433.
[7]俞长君,李雪萍,林强,等.呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响[J].中华物理医学与康复杂志,2016,38(10):735-739.
[8]王新德.各类脑血管疾病诊断要点[J].中华神经科杂志,1996(6):379-380.
[9]姜晖,王丽萍,吉鹏,等.声门上型喉癌和下咽癌对吞咽功能影响的初步探讨[J].听力学及言语疾病杂志,2018,26(1):29-33.
[10]苏文华,阎文静,钟明华,等.神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及其表面肌电图的影响[J].中华物理医学与康复杂志,2015,37(3):183-186.
[11]董德朋,袁雷,赵扬,等.人体自由负重深蹲在稳定与非稳定条件下肌肉iEMG比较研究[J].天津体育学院学报,2017,32(2):162-168.
[12]宁璞,杨菁菁,孙铁英,等.住院老年人吸入性肺炎患病率及其危险因素分析[J].中华老年医学杂志,2017,36(4):428-432.
[13]Ward K,Seymour J,Steier J,et al.Acute ischaemic hemi-spheric stroke is associated with impairment of reflex in addition to voluntary cough[J].Eur Respir J,2010,36(6):1383-1390.
[14]张焱,王敏,傅小利,等.环状软骨上喉部分切除术后早期吞咽功能训练的临床应用[J].局解手术学杂志,2017,26(10):776-779.
[15]Messaggi-Sartor M,Guillen-SolàA,Depolo M,et al.Inspiratory and expiratory muscle training in subacute stroke:A randomized clinical trial[J].Neurology,2015,85(7):564-572.
[16]陈勇,王宝强,何潇,等.阻力呼吸器训练对肺癌放疗后患者生命质量及肺功能的影响[J].中华物理医学与康复杂志,2017,39(4):297-299.
[17]杨华,张洪宇,高茹,等.23例喉癌患者环状软骨上喉部分切除术后吞咽功能评估与康复训练[J].护理学报,2016,23(11):58-60.
[18]钟志明,田文栋,刘雄,等.环状软骨上喉部分切除术后吞咽功能评估的初步研究[J].中华耳鼻咽喉头颈外科杂志,2015,50(2):95-100.
[19]Similow T,Catala M,Rancurel G,et al.Impairment of central motor conduction to the diaphragm in stroke[J].Am J Respir Crit Care Med,1996,154(1):436-441.
[20]杨初燕,冯珍,刘玲玲.呼吸功能训练对脑卒中伴老年慢性阻塞性肺病患者吞咽功能的影响[J].中华物理医学与康复杂志,2015,37(4):266-268.
[21]Kulnik ST,Rafferty GF,Birring SS,et al.A pilotstudy of respiratory muscle training to improve cough effectiveness and reduce the incidence of pneumonia in acute stroke:Study protocol for a randomized controlled trial[J].Trials,2014,15(1):123.