吞咽神经肌肉电刺激联合舌压抗阻反馈训练对中风后吞咽障碍患者吞咽功能和生活质量的影响  

Effects of swallowing neuromuscular electrical stimulation combined with tongue pressure resistance feedback training on swallowing function and quality of life in patients with post-stroke dysphagia

作　　者：秦科 王洪军 余铉 冉莉 徐耀 李兴义 龚自力 Qin Ke;Wang Hongjun;Yu Xuan;Ran Li;Xu Yao;Li Xingyi;Gong Zili(Department of Neurology,Fengdu General Hospital,Chongqing 408200,China;Department of Neurology,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)

机构地区：[1]重庆市丰都县人民医院神经内科,重庆408200 [2]陆军军医大学新桥医院神经内科,重庆400037

出　　处：《保健医学研究与实践》2024年第11期79-85,共7页Health Medicine Research and Practice

基　　金：重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX0944)。

摘　　要：目的探讨吞咽神经肌肉电刺激(NMES)联合舌压抗阻反馈训练(TPRFT)对卒中后吞咽障碍(PSD)患者吞咽功能和生活质量的影响,以期为临床制定PSD的治疗和康复方案提供参考。方法选取重庆市丰都县人民医院2019年2月—2023年2月收治的99例PSD患者,采用随机数字表法分为对照组(49例)和观察组(50例)。对照组患者接受吞咽NMES治疗,观察组患者接受吞咽NMES联合TPRFT。比较2组患者治疗后的康复效果,治疗前后的吞咽功能、舌压情况、舌骨喉复合体活动度、生活质量以及治疗期间并发症发生情况。结果观察组患者治疗后的康复效果优于对照组,差异有统计学意义(Z=10.660,P<0.001)。治疗前,2组患者吞咽X电视透视检查(VFSS)评分比较,差异无统计学意义(P>0.05);治疗后,2组患者VFSS评分均高于治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者舌压平均值、舌压持续时间、舌压峰值比较,差异均无统计学意义(P>0.05);治疗后,2组患者舌压平均值、舌压持续时间、舌压峰值均大于治疗前,且观察组均大于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者舌骨前移距离、舌骨上移距离、甲状软骨上移距离、甲状软骨前移距离比较,差异均无统计学意义(P>0.05),治疗后,2组患者舌骨前移距离、舌骨上移距离、甲状软骨上移距离、甲状软骨前移距离均大于治疗前,且观察组均大于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者吞咽障碍特异性生活质量量表(SWAL-QQL)各维度评分比较,差异均无统计学意义(P>0.05);治疗后,2组患者SWAL-QQL量表各维度评分均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组患者治疗期间并发症发生率为6.00%(3/50),低于对照组的20.40%(10/49),差异有统计学意义(χ^(2)=4.504,P=0.034)。结论吞咽NMES联合TPRFT有助于改善PSD患者的吞咽功能Objective To investigate the effects of swallowing neuromuscular electrical stimulation(NMES)combined with tongue pressure resistance feedback training(TPRFT)on swallowing function and quality of life in patients with post-stroke dysphagia(PSD),providing a reference for clinical treatment and rehabilitation strategies for PSD.Methods A total of 99 PSD patients admitted to Fengdu General Hospital from February 2019 to February 2023 were selected and randomly divided into a control group(49 cases)and an observation group(50 cases)using a random number table.The control group re-ceived swallowing NMES treatment,while the observation group received swallowing NMES combined with TPRFT.The rehabilitation outcomes,swallowing function,tongue pressure,hyolaryngeal complex mobility,quality of life,and complications during treatment were compared between the two groups before and after treatment.Results The rehabilitation outcomes in the observation group were significantly superior to those in the control group(Z=10.660,P<0.001).Before treatment,no significant difference was observed in videofluoroscopic swallowing study(VFSS)scores between the two groups(P>0.05).After treatment,VFSS scores in both groups were significantly higher than before treatment,and the observation group had significantly higher scores than the control group(P<0.05).Before treatment,no significant differences were noted in average tongue pressure,tongue pressure duration,or peak tongue pressure between the two groups(P>0.05).After treatment,these metrics improved significantly in both groups,with the observation group showing greater improvements than the control group(P<0.05).Before treatment,no significant differences were observed in hyoid anterior displacement,hyoid superior displacement,thyroid cartilage superior displacement,or thyroid cartilage anterior displacement between the two groups(P>0.05).After treatment,these measures increased significantly in both groups,with the observation group showing greater increases than the control group(P<

关 键 词：卒中后吞咽障碍 吞咽神经肌肉电刺激 舌压抗阻反馈训练 吞咽功能 生活质量 

分 类 号：R743.3[医药卫生—神经病学与精神病学]