神经肌肉电刺激治疗脑损伤继发吞咽障碍的临床效果
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摘要
目的:探讨神经肌肉电刺激疗法对脑损伤继发吞咽障碍患者的治疗效果。方法:采用随机对照双盲的设计方案,将46例患者随机分为试验组(23例)和对照组(23例),试验组患者采用神经肌肉电刺激联合常规康复治疗,对照组患者采用同样的治疗方法,但不通电流,在治疗前、后分别对患者分别进行FOIS评分及VFSS检查,以评价其临床治疗效果。结果:两组治疗后与治疗前相比,FOIS评分均升高,但试验组升高更明显,与对照组相比差异有统计学意义(P=0.000 3);试验组、对照组在治疗后VFSS评分与治疗前相比均升高(P=0.000 0、0.002 4),试验组升高更为明显,且与对照组相比差异有统计学意义(P=0.002 3)。在吞咽时间方面,试验组治疗后,其食物在口腔内运输时间、咽延迟时间、咽运输时间三者均低于治疗前,差异有统计学意义(P=0.000 0、0.000 0、0.012 4);而对照组与治疗前相比差异无统计学意义(P>0.05);治疗后,试验组和对照组相比差异均有统计学意义(P=0.000 0、0.000 0、0.000 3)。结论:神经肌肉电刺激疗法联合常规康复治疗是治疗吞咽障碍的首选方案,其操作性好、安全性高,值得在临床中广泛应用。
Objective:To investigate the clinical effect of neuromuscular electrical stimulation treatment for secondary dysphagia after brain injury.Method:Using randomized controlled double-blind design scheme,46 cases were divided into the trial group(23 cases) and the control group(23 cases).The trial group used neuromuscular electrical stimulation combined with conventional rehabilitation,and the control group used the same therapeutic maneuver,but no electric current.In order to compare the clinical effect,all the cases were evaluated by FOIS and VESS before and after treatment respectively.Result:Compared to the treatment before,the FOIS scores were elevated in two groups after treatment,but the trial group elevated more significantly than control group(P=0.000 3).Compared to the treatment before,the VFSS scores were elevated in the trail group and the control group after treatment(P=0.000 0,0.002 4),but the trail group elevated more significantly than the control group(P=0.002 3).In terms of swallowing time,the food transportation time in oral cavity,pharyngeal delay time and pharyngeal transportation time of the trail group were significantly better after treatment than before(P=0.000 0,0.000 0,0.012 4),but those results were not observed in the control group(P>0.05).After treatment,there were significantly among the trial group and the control group(P=0.000 0,0.000 0,0.000 3).Conclusion:The therapeutic maneuver of neuromuscular electrical stimulation combined with conventional rehabilitation shall be considered as preferred scheme for its good operability and safety.So we believe this therapeutic maneuver shall be applied in clinical work.
Objective:To investigate the clinical effect of neuromuscular electrical stimulation treatment for secondary dysphagia after brain injury.Method:Using randomized controlled double-blind design scheme,46 cases were divided into the trial group(23 cases) and the control group(23 cases).The trial group used neuromuscular electrical stimulation combined with conventional rehabilitation,and the control group used the same therapeutic maneuver,but no electric current.In order to compare the clinical effect,all the cases were evaluated by FOIS and VESS before and after treatment respectively.Result:Compared to the treatment before,the FOIS scores were elevated in two groups after treatment,but the trial group elevated more significantly than control group(P=0.000 3).Compared to the treatment before,the VFSS scores were elevated in the trail group and the control group after treatment(P=0.000 0,0.002 4),but the trail group elevated more significantly than the control group(P=0.002 3).In terms of swallowing time,the food transportation time in oral cavity,pharyngeal delay time and pharyngeal transportation time of the trail group were significantly better after treatment than before(P=0.000 0,0.000 0,0.012 4),but those results were not observed in the control group(P>0.05).After treatment,there were significantly among the trial group and the control group(P=0.000 0,0.000 0,0.000 3).Conclusion:The therapeutic maneuver of neuromuscular electrical stimulation combined with conventional rehabilitation shall be considered as preferred scheme for its good operability and safety.So we believe this therapeutic maneuver shall be applied in clinical work.
引文
[1]中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍康复评估与治疗专家共识(2013年版)[J].中华物理医学与康复杂志,2013,35(12):916-929.
[2] Kushner D S,Peters K,Eroglu S T,et al.Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation[J].Am J Phys Med Rehabil,2013,92(6):486-495.
[3]张月兰,李明,罗莎,等.神经肌肉电刺激治疗脑卒中后吞咽功能障碍的疗效观察[J].中国实用神经疾病杂志,2015,39(8):65-66.
[4]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社,2009:148-165.
[5]方定华,陈小海,李漪,等.脑血管病临川与康复[M].上海:上海科学技术文献出版社,2001:110.
[6] Park J W,Oh J C,Lee H J,et al.Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing[J].Dysphagia,2009,24:296-301.
[7]李晏.神经肌肉电刺激联合康复训练对不同病理特点急性脑卒中患者吞咽障碍的疗效[J].中国老年学杂志,2018,38(1):87-90.
[8] Crary M A,Groher M E.Introduction to adult swallowing disorders[M].Butterworth-Heinemann Medical,2003.
[9] Terre R,Martinell M,Gonz alez B,et al.Treatment of oropharyngeal dysphagia with neuromuscular electrostimulation[J].Med Clin(Barc),2013,140:157-160.
[10] Springer S,Laufer Y,Becher M,et al.Dual-channel functionalelectrical stimulation improvements in speed-based gait classifications[J].Clin Interv Aging,2013,8:271-277.
[11]徐明馨,王强,孟萍萍,等.强化神经肌肉电刺激联合吞咽功能训练治疗脑卒中后吞咽功能障碍的疗效观察[J].中华物理医学与康复杂志,2014,36(4):274-277.
[12] Heijnen B J,Speyer R,Baijens L W,et al.Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia:effects on quality of life[J].Dysphagia,2012,27(3):336-345.
[13]冀旗玲,曾艳芳,杜会山.神经肌肉电刺激对脑卒中后吞咽困难的疗效[J].中国老年学杂志,2018,38(22):5414-5416.
[2] Kushner D S,Peters K,Eroglu S T,et al.Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation[J].Am J Phys Med Rehabil,2013,92(6):486-495.
[3]张月兰,李明,罗莎,等.神经肌肉电刺激治疗脑卒中后吞咽功能障碍的疗效观察[J].中国实用神经疾病杂志,2015,39(8):65-66.
[4]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社,2009:148-165.
[5]方定华,陈小海,李漪,等.脑血管病临川与康复[M].上海:上海科学技术文献出版社,2001:110.
[6] Park J W,Oh J C,Lee H J,et al.Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing[J].Dysphagia,2009,24:296-301.
[7]李晏.神经肌肉电刺激联合康复训练对不同病理特点急性脑卒中患者吞咽障碍的疗效[J].中国老年学杂志,2018,38(1):87-90.
[8] Crary M A,Groher M E.Introduction to adult swallowing disorders[M].Butterworth-Heinemann Medical,2003.
[9] Terre R,Martinell M,Gonz alez B,et al.Treatment of oropharyngeal dysphagia with neuromuscular electrostimulation[J].Med Clin(Barc),2013,140:157-160.
[10] Springer S,Laufer Y,Becher M,et al.Dual-channel functionalelectrical stimulation improvements in speed-based gait classifications[J].Clin Interv Aging,2013,8:271-277.
[11]徐明馨,王强,孟萍萍,等.强化神经肌肉电刺激联合吞咽功能训练治疗脑卒中后吞咽功能障碍的疗效观察[J].中华物理医学与康复杂志,2014,36(4):274-277.
[12] Heijnen B J,Speyer R,Baijens L W,et al.Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia:effects on quality of life[J].Dysphagia,2012,27(3):336-345.
[13]冀旗玲,曾艳芳,杜会山.神经肌肉电刺激对脑卒中后吞咽困难的疗效[J].中国老年学杂志,2018,38(22):5414-5416.