二腹肌针刺电刺激联合嗓音训练治疗主动脉弓部手术后吞咽及嗓音障碍的随机对照试验  

Effects of digastric muscle low frequency modulated medium frequency electroacupuncture therapy and voice training for dysphagia in patients with aortic arch surgery:A randomized controlled trial

作　　者：彭继海[1] 范小平[2] 任庆宜 张鸣生[1] 杜健茹[1] 汤惠冰 PENG Jihai;FAN Xiaoping;REN Qingyi;ZHANG Mingsheng;DU Jianru;TANG Huibing(Department of Rehabilitation, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, P.R. China;Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences. Guanezhou, 510080. P.R. China)

机构地区：[1]广东省人民医院康复医学科广东省医学科学院,广州510100 [2]广东省心血管病研究所心外科广东省人民医院广东省医学科学院,广州510080

出　　处：《中国胸心血管外科临床杂志》2018年第6期489-494,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省医学科学技术研究基金面上项目(2016115114137325);广东省中医药局科研项目(20161003);国家自然科学基金面上项目(81372114);广东省自然科学基金面上项目(2016A030313792)

摘　　要：目的探讨二腹肌针刺电刺激联合嗓音训练对主动脉弓部手术后吞咽障碍患者吞咽功能康复的影响。方法将我院2014年10月至2017年11月连续42例主动脉弓部手术后吞咽障碍患者采用分层随机化分成观察组和对照组,每组各21例。其中观察组中男17例、女4例,年龄(51.0±6.5)岁。对照组中男18例、女3例,年龄(49.8±7.3)岁。观察组进行二腹肌针刺电刺激联合嗓音训练(2周,每天一次,每次各20 min),对照组进行吞咽健康宣教及康复指导,比较两组患者干预前后纤维喉镜、经口摄食功能评估量表(functional oral intake scale,FOIS)进食量表及计算机嗓音分析等客观评估指标。结果观察组经过二腹肌针刺电刺激联合嗓音训练后患者呛咳明显减少,纤维喉镜下左侧声带闭合程度较治疗前显著性提高;患者FOIS进食量表分数较治疗前显著性提高(6.30 vs.4.60,P<0.05),声门闭合程度较治疗前显著性改善(1.00 vs.1.70,P<0.05);两组患者嗓音嘶哑各项指标均较治疗前明显改善,观察组基频微扰(0.60%±0.96%vs.1.99%±1.86%,P=0.033)、振幅微扰(2.47%±4.26%vs.5.89%±3.66%,P=0.043)、最长发声时间[(15.31±9.10)s vs.(3.72±8.83)s,P=0.006]、最长最大音发声时间[(9.30±5.73)s vs.(2.32±2.99)s,P=0.039]、噪谐比(23.99±10.17 vs.9.98±9.37,P=0.006)以及谐噪比(0.03±0.02 vs.0.17±0.23,P=0.019)6项指标改善情况明显优于对照组。结论二腹肌针刺电刺激联合嗓音训练可以明显改善主动脉弓部手术后吞咽障碍患者的吞咽功能,促进嗓音恢复,提高患者进食及交流能力。Objective To investigate the combined effects of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training for dysphagia in patients who underwent aortic arch surgery. Methods Forty-two consecutive patients with dysphagia after aortic arch surgery between October 2014 and November 2017 were divided into two groups including an observation group and a control group. There were 21 patients in each group. There were 17 males and 4 females at age of 51.0±6.5 years in the observation group, while 18 males and 3 females at age of 49.8±7.3 years in the control group. The patients in the observation group underwent electroacupuncture therapy and voice training （20 min per day for each therapy, 2 weeks）, while the patients in the control group only received safe swallowing education and rehabilitation guidance （2 weeks）. The test results, such as fibrolaryngoscope and functional oral intake scale （FOIS） score, and the data of computer phonatory detection, before and after the intervention were compared. Results The fibrolaryngoscope of vocal cords significantly decreased and the FOIS score significantlyincreased after digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training in the observation group（6.30 vs. 4.60, P〈0.05）. Bucking was obviously reduced. The indicators of hoarse degree, such as median pitch, fundamental frequency, jitter （0.60%±0.96% vs. 1.99%±1.86%, P=0.033）, shimmer （2.47%±4.26% vs. 5.89%±3.66%, P=0.043）, maximum phonation time （15.31±9.10 s vs. 3.72±8.83 s, P=0.006）, maximum and loud phonation time （9.30±5.73 s vs. 2.32±2.99 s, P=0.039）, mean noise-to-harmonics ratio （23.99±10.17 vs .9.98±9.37, P=0.006） and mean harmonics-to-noise ratio （0.03±0.02 vs. 0.17±0.23, P=0.019） improved after the treatment in both groups. But the improvement in the observation group was significantly better than that in the control group. Conclusion The combination of digastric m

关 键 词：低频调制中频电 针刺 二腹肌 主动脉弓部手术 吞咽障碍 

分 类 号：R654.3[医药卫生—外科学]