脑卒中吞咽障碍患者吞咽相关肌群活动与呼吸肌功能关系研究  

Study on the Relationship between Swallowing-Related Muscle Activity and Respiratory Muscle Function in Stroke Patients with Dysphagia

作　　者：苏盼盼 何川 冯敏 贾园园 王甜甜 孟殿怀[2] SU Panpan;HE Chuan;FENG Min;JIA Yuanyuan;WANG Tiantian;MENG Dianhuai(Jiangsu Shengze Hospital,Suzhou,Jiangsu 215000,China;The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]江苏盛泽医院,江苏苏州215000 [2]南京医科大学第一附属医院,江苏南京210029

出　　处：《康复学报》2024年第5期450-456,共7页Rehabilitation Medicine

基　　金：江苏省重点研发项目(BE2021012-4);苏州市科技发展计划项目(SYSD2020045);苏州市吴江区科教兴卫项目(WWK201929)。

摘　　要：目的通过表面肌电图(sEMG)研究呼吸肌无力对脑卒中吞咽障碍患者吞咽过程中吞咽相关肌群活动的影响,探讨脑卒中吞咽障碍患者吞咽相关肌群活动与呼吸肌功能的相关性。方法选取江苏盛泽医院于2022年12月—2023年10月符合纳入标准的脑卒中吞咽障碍患者40例为研究对象,另选取资料匹配的15名健康受试者为对照组。使用肺功能检测仪评估所有受试者的最大吸气压(MIP)和最大呼气(MEP),研究组根据MEP和MIP测试结果,将40例脑卒中患者分为非呼吸肌无力组(MIP≥预计值70%和/或MEP≥预计值70%)15例和呼吸肌无力组(MIP<预计值70%且MEP<预计值70%)25例。受试者吞咽5 mL水时,通过sEMG采集健侧、患侧颏下肌群及舌骨下肌群的sEMG信号,比较3组间健、患两侧的均方根值和峰值振幅,并对患者sEMG信号与呼吸肌功能进行相关性分析。结果呼吸肌无力组MIP和MEP低于非呼吸肌无力组和对照组(P<0.05)。呼吸肌无力组患侧颏下肌群的sEMG均方根值和峰值振幅低于非呼吸肌无力组和对照组(P<0.05),呼吸肌无力组健侧颏下肌群sEMG峰值振幅低于对照组(P<0.05),呼吸肌无力组患侧颏下肌群的sEMG均方根值和峰值振幅低于健侧(P<0.05)。脑卒中吞咽障碍患者患侧颏下肌群均方根值和峰值振幅、健侧颏下肌群峰值振幅与MIP呈正相关(r=0.366,r=0.415,r=0.317,P<0.05);患侧颏下肌群、健侧颏下肌群、患侧舌下肌群均方根值及峰值振幅与MEP呈正相关(r=0.534,r=0.595,r=0.332,r=0.455,r=0.323,r=0.375,P<0.05)。结论伴有呼吸肌无力的脑卒中吞咽障碍患者颏下肌群力量明显下降,且脑卒中吞咽障碍患者吞咽相关肌群活动与呼吸肌功能存在相关性。Objective To study the effect of respiratory muscle weakness on the activity of swallowing-related muscle groups during swallowing in stroke patients with dysphagia by surface electromyography(sEMG),and to investigate the correlation between activity of swallowing-related muscle groups and respiratory muscle function.Methods A total of forty patients with dysphagia after stroke who met the inclusion criteria from December 2022 to October 2023 at Jiangsu Shengze Hospital of Nanjing Medical University were selected as the research group,and another 15 healthy individuals with matched data were selected as the control group.Maximum inspiratory pressure(MIP)and maximum expiratory pressure(MEP)of all subjects were assessed using a pulmonary function tester.The 40 stroke patients were divided into non-respiratory muscle weakness group(MIP≥70%and/or MEP≥70%of predicted values)of 15 patients and respiratory muscle weakness group(MIP<70%and MEP<70%of predicted values)of 25 patients based on the results of MEP and MIP tests.sEMG was used to collect the signals from the submental muscles and infrahyoid muscles on both the healthy and affected sides of all subjects while swallowing 5 mL of water.The root mean square values and peak amplitudes were compared among the three groups and between the healthy and affected sides,and a correlation analysis was performed between the sEMG signals and respiratory muscle function in the study group.Results MIP and MEP of the respiratory muscle weakness group were significantly lower than those of the non-respiratory muscle weakness group and the control group(P<0.05).The root mean square and peak amplitude of sEMG signals from submental muscles of the affected side in the respiratory muscle weakness group were significantly lower than those in the non-respiratory muscle weakness group and the control group(P<0.05),and the peak amplitude of sEMG signals from submental muscles of the healthy side in the respiratory muscle weakness group was significantly lower than that of the control

关 键 词：脑卒中 吞咽障碍 吞咽相关肌群 表面肌电图 呼吸肌功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]