表面肌电生物反馈及神经肌肉电刺激对脑干损伤后吞咽障碍患者吞咽功能的即时效应  

The effect of surface electromyogram biofeedback and neuro muscular electrical stimulation on pharyngeal and upper esophageal sphincter function in brain stem injury patients with dysphagia

作　　者：兰月[1] 王茜媛 徐光青[2] 窦祖林[1] 于帆[1] 林拓[1] 

机构地区：[1]中山大学附属第三医院康复医学科,广州510630 [2]中山大学附属第一医院康复医学科

出　　处：《中国康复医学杂志》2014年第5期405-409,共5页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金青年基金(81101460);广州市科技计划项目对外科技合作专项(2012J5100022);中央高校基本科研业务费专项资金(12ykpy38)

摘　　要：目的:使用高分辨率固态测压系统(HRM)评价表面肌电生物反馈(sEMGBF)及神经肌肉电刺激(NMES)对脑干损伤后神经源性吞咽障碍患者咽部及食管上括约肌(UES)功能的即时影响。方法:脑干损伤后吞咽障碍患者15例,分别在表面肌电生物反馈、神经肌肉电刺激及无干预措施下吞咽唾液(干吞咽)2次及吞咽3ml水2次。用高分辨率固态测压系统实时采集咽部及食管上括约肌的压力及时间参数。参数包括:咽部收缩峰值压,咽部收缩持续时间,咽部收缩速率,UES松弛残余压,UES松弛持续时间。使用重复测量的方差分析研究表面肌电生物反馈疗法及神经肌肉电刺激对这些参数的影响。结果:与无干预状态时相比,干咽时sEMG组吞咽时UES松弛持续时间延长(P=0.042),咽部收缩峰值增加(P=0.029),咽部收缩速率提高(P=0.016),咽部收缩持续时间延长(P=0.048)。NMES组咽部收缩持续时间延长(P=0.041)。吞咽3ml水时,sEMG组吞咽时UES松弛持续时间延长(P=0.033),咽部收缩速率提高(P=0.007),咽部收缩持续时间延长(P=0.044)。NMES组UES松弛残余压升高(P=0.020),咽部收缩速率有所降低(P=0.008),咽部收缩持续时间延长(P=0.039)。结论:表面肌电生物反馈可以显著延长食管上括约肌松弛持续时间和咽部收缩持续时间;神经肌肉电刺激会显著增加食管上括约肌松弛残余压,降低咽部收缩速率,但是可以显著增加咽部收缩持续时间。Objective： To quantify the effect of surface electromyogram biofeedback （sEMGBF） and neuro muscular electri- cal stimulation （NMES） on pharyngeal pressure and upper esophageal sphincter （UES） function using high reso- lution manometry （HRM） in brain stem injury patients with dysphagia. Method： Fifteen patients with pharyngeal swallowing disorder after brain stem injury were involved in this study. All subjects were experienced dry swallowing and 3ml water swallowing twice in three conditions： sEMGBF, NMES and neutral. Pressure and timing parameters were recorded by HRM system. The parameters included the pharyngeal maximum pressure, rate of pharyngeal pressure increased, duration of pharyngeal pres- sure above baseline, duration of UES relaxation, and UES residual pressure. Result： Compared with neural condition, duration of UES relaxation prolonged （P=0.042）, pharyngeal maximum pressure increased （P=0.029）, rate of pharyngeal pressure increased（P=-0.016）, and duration of pharyngeal pres- sure prolonged （P=-0.048） in sEMG condition during dry swallowing. Duration of pharyngeal pressure prolonged （P=0.041） in NMES condition during dry swallowing. During swallow 3ml water, duration of UES relaxation prolonged （P=0.033）, rate of pharyngeal pressure increased （P--0.007）, and duration of pharyngeal pressure pro- longed （P=0.044） in sEMG condition, duration of pharyngeal pressure（P=0.039）, UES residual pressure increased （P=0.020）, rate of pharyngeal pressure decreased （P=-0.008） in NMES condition during dry swallowing. Conclusion： sEMGBF have significantly effect on duration of UES relaxation and duration of pharyngeal pres- sure. NMES can significant prolong the duration of pharyngeal pressure, increase UES relaxation residual pres- sure and decrease the rate of pharyngeal pressure.

关 键 词：吞咽障碍 高分辨率测压 神经肌肉电刺激 表面肌电生物反馈 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R454.1[医药卫生—临床医学]