脑卒中后不同程度吞咽障碍患者的表面肌电图特点  

Surface electromyographic characteristics of different degrees of dysphagia after stroke

作　　者：吴文秀[1] 余见苍 周雪珍[1] 卓飞南 WU Wenxiu;YU Jiancang;ZHOU Xuezhen;ZHUO Feinan(Department of Rehabilitation Medicine,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院康复医学科,325000

出　　处：《浙江医学》2020年第15期1618-1623,共6页Zhejiang Medical Journal

基　　金：温州科技局基金项目(Y20150028)。

摘　　要：目的了解脑卒中后不同程度吞咽障碍患者的表面肌电图特点,初步探讨吞咽障碍的发生机制。方法选取2017年10月至2018年2月温州医科大学附属第一医院康复医学科脑卒中患者166例。根据吞咽功能评估量表的结果分为4组:无吞咽障碍组74例,轻度吞咽障碍组22例,中度吞咽障碍组50例,重度吞咽障碍组20例。采用表面肌电图技术记录患者在空吞咽、进食糊状食物、10 ml液体和固体食物时颏下肌群和舌骨下肌群的肌电活动情况(平均振幅、峰值、时限)。结果空吞咽时重度吞咽障碍组颏下肌群的峰值为(244.88±82.83)m V、平均振幅为(58.88±33.74)m V,均较无吞咽障碍组[(432.07±186.39)、(77.82±30.60)m V]低,而时限[(1.46±0.46)s]长于无吞咽障碍组[(1.29±0.41)s],同时舌骨下肌群的峰值[(144.94±78.70)m V]低于无吞咽障碍组[(236.61±123.71)m V],时限[(1.53±0.53)s]长于无吞咽障碍组[(1.26±0.39)s],差异均有统计学意义(均P<0.05)。在糊状食物、10 ml液体、固体食物测试时,重度吞咽障碍组均无法完成,中度吞咽障碍组在糊状食物、10 ml液体和固体食物测试时颏下肌群的时限[(1.69±0.73)、(1.67±0.73)、(1.77±0.69)s]长于无吞咽障碍组[(1.30±0.47)、(1.22±0.37)、(1.31±0.58)s],且舌骨下肌群的时限[(1.53±0.66)、(1.63±0.70)、(1.77±0.61)s]长于无吞咽障碍组[(1.24±0.45)、(1.24±0.36)、(1.28±0.50)s],轻度吞咽障碍组在10 ml液体测试时颏下肌群的平均振幅[(104.00±32.59)m V]大于无吞咽障碍组[(84.91±30.49)m V],固体食物测试时舌骨下肌群时限[(1.59±0.91)s]长于无吞咽障碍组[(1.28±0.50)s],差异均有统计学意义(均P<0.05),其余指标比较差异均无统计学意义(均P>0.05)。结论脑卒中后不同程度吞咽障碍患者颏下肌群及舌骨下肌群表面肌电活动存在差异性,可能与吞咽障碍的严重程度相关。轻度吞咽障碍患者可能仅仅表现进食液体食物时平均振幅增高,进食固�Objective To investigate the surface electromyographic characteristics of different degrees of dysphagia after stroke.Methods One hundred and sixty-six patients with stroke admitted in the Department of Rehabilitation Medicine of the First Affiliated Hospital of Wenzhou Medical University were enrolled in the study.The mean age of the patients was 64.64±13.10 years;108 were males and 58 were females.According to the results of the Gugging Swallowing Screen,there were 92 patients with different degrees of dysphagia,including 22 cases of mild dysphagia,50 cases of moderate dysphagia,and 20 cases of severe dysphagia.Surface electromyography was performed,and the mean amplitude,peak amplitude of the submental muscles and infrahyoid muscles were recorded when the patients swallowed saliva,paste-based meals,10 mL of fluid,and solid foods.Results During saliva swallowing,the peak and mean amplitude of the submental muscles in patients with severe swallowing disorders(244.88±82.83 and 58.88±33.74 mV)were lower than those in patients without dysphagia(432.07±186.39 and 77.82±30.60 mV];the swallowing time(1.46±0.46 s)was longer than that in those without dysphagia(1.29±0.41 s).The peak amplitude of the infrahyoid muscles in patients with severe swallowing disorders was decreased(144.94±78.70 vs.236.61±123.71 mV),and the swallowing time was prolonged(1.53±0.53 vs.1.26±0.39 s)compared with those in patients without dysphagia(all P<0.05).When tested with different foods including paste-based meals,10 mL of fluid,and solid foods,patients with severe dysphagia were not able to complete the test.The swallowing times of the submental muscles in patients with moderate dysphagia were prolonged compared with that in patients without dysphagia(1.69±0.73,1.67±0.73 and 1.77±0.69 vs.1.30±0.47,1.22±0.37,and 1.31±0.58 s,respectively).The swallowing times of the infrahyoid muscles were prolonged in patients with moderate dysphagia compared with those in patients without dysphagia(1.53±0.66,1.63±0.70,and 1.77±0.61 vs.1.2

关 键 词：脑卒中 吞咽障碍 表面肌电图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]