体外膈肌起搏器治疗结合吞咽功能训练对原发性帕金森病吞咽功能的疗效  

Effects of Extracorporeal Diaphragm Pacemaker Therapy Combined with Routine Swallowing Training on Dysphagia in Patients with Primary Parkinson’s Disease

作　　者：甘莉 王磊[1] 龚玉来 魏鹏绪 王红艳[1] 胥国文 GAN Li;WANG Lei;GONG Yu-Lai;WEI Peng-xu;WANG Hong-yan;XU Guo-wen(Department of Hearing and Speech Reha-bilitation,Affiliated Sichuan Ba-Yi Rehabilitation Center of Chengdu University of TCM,Chengdu 610000,Chi-na;Department of Comprehensive Rehabilitation,Rehabilitation Hospital Affiliated to National Rehabilitation Assistance Research Center,Beijing 100176,China)

机构地区：[1]成都中医药大学附属四川省八一康复中心,成都610000 [2]国家康复辅具研究中心附属康复医院综合康复科,北京100176

出　　处：《神经损伤与功能重建》2021年第6期316-318,322,共4页Neural Injury and Functional Reconstruction

基　　金：四川省科技厅重点项目(2018JY0664)。

摘　　要：目的:观察体外膈肌起搏器(EDP)治疗结合吞咽功能常规训练对原发性帕金森病(PD)吞咽功能的疗效。方法:PD合并吞咽障碍患者42例随机分为对照组和观察组。在PD常规治疗的基础上,对照组接受吞咽功能常规训练,观察组在此基础上再配合EDP治疗。分别在治疗前、治疗4周后进行吞咽造影检查(VFSS),并采用洼田饮水试验、Rosenbek渗透-误吸等级量表(PAS)、改良钡剂吞咽障碍造影(MBSS)、柠檬酸诱导咳嗽反射测验(CRT)、Borg呼吸困难指数评分、运动自觉用力程度量表(RPE)对2组患者进行评定,观察吞咽功能、咳嗽反射、呼吸疲劳程度改善情况。结果:治疗前,2组的饮水试验、PAS、MBSS、Borg、RPE评分及CRT通过率差异无统计学意义(P>0.05)。治疗4周后,2组的饮水试验、PAS、MBSS、Borg、RPE评分均较同组治疗前降低(均P<0.05),且观察组低于对照组(均P<0.05);2组的CRT通过率较同组治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。结论:EDP治疗结合常规吞咽训练对合并吞咽障碍的原发性PD患者吞咽功能的疗效优于单一吞咽训练。Objective: To observe the effect of external diaphragm pacemaker(EDP) therapy combined with routine swallowing training on swallowing function in patients with primary Parkinson’s disease(PD). Methods: A total of 42 PD patients with dysphagia were randomly divided into the observation group and control group. Both groups received conventional treatment for PD and standard swallowing training, and the observation group was additionally treated with an EDP. The videofluoroscopic swallow study(VFSS), Watian water drinking test, Rosenbek penetration-aspiration scale(PAS), modified barium swallow study(MBSS), citric acid cough reflex test(CRT), Borg breathlessness scale, and rating of perceived exertion(RPE) scale were performed before and 4-week after treatment to evaluate the improvement in swallowing function, cough reflex, and respiratory fatigue of two groups. Results: Before treatment, there was no statistically significant difference in the water drinking test, PAS, MBSS, Borg, and RPE scores and in the CRT pass rate between the two groups(P>0.05).Compared with before treatment within the same group, the water drinking test, PAS, MBSS, Borg, and RPE scores after 4 weeks of treatment were all decreased(all P<0.05), with the observation group showing a greater decrease than the control group(all P<0.05). Within the same group, the CRT pass rate after treatment was increased compared to before treatment(P<0.05), and the observation group showed a greater increase(P<0.05).Conclusion: In primary PD patients, EDP therapy combined with standard swallowing training yields better results than swallowing training alone.

关 键 词：帕金森病 吞咽障碍 体外膈肌起搏器 咳嗽反射 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]