表面肌电生物反馈治疗对卒中后吞咽功能障碍患者咽期活动的影响

摘要

目的：观察表面肌电生物反馈治疗对卒中后吞咽功能障碍患者咽期活动的影响。方法前瞻性连续纳入2014年8月至2015年2月南京医科大学附属南京脑科医院康复医学科及神经内科收治的卒中后咽期吞咽功能障碍患者76例，在排除40例患者后，采用随机数字表法将余36例患者完全随机分为常规训练组（19例）和生物反馈组（17例）。给予常规训练组患者单纯吞咽功能训练，生物反馈组在常规训练组治疗方案的基础上辅以表面肌电生物反馈治疗。两组患者均每周训练6次，共训练4周。于训练前和训练后进行吞咽造影评估并进行数字化测量分析。测量指标包括食管上括约肌（UES ）开放程度、咽期通过时间（PTT ）、舌骨最大位移距离（HmaxD）。结果（1）常规训练组训练前后UES完全开放率分别为26.3％（5／19）和47.4％（9／19），训练前后比较，差异有统计学意义（χ2＝5.08，P＝0.020）；生物反馈组训练前后UES完全开放率分别为47.1％（8／17）和82.4％（14／17），训练前后比较，差异有统计学意义（χ2＝11.46，P＝0.001）；两组训练前UES完全开放程度比较，差异无统计学意义（P＞0.05）；两组训练后UES完全开放程度比较，差异有统计学意义（χ2＝4.63，P＝0.040）。（2）常规训练组训练前后PTT分别为（0.24±0.07）、（0.19±0.06）s，生物反馈组训练前后PTT分别为（0.23±0.06）和（0.15±0.05）s，两组训练前后比较，差异有统计学意义（F＝154.50，P＝0.000）；两组训练前PTT比较，差异无统计学意义（P＞0.05）；两组训练后PTT比较，差异有统计学意义（F＝4.66，P＝0.038）。（3）常规训练组训练前后HmaxD分别为（0.5±0.4）、（0.9±0.4）cm，生物反馈组训练前后PTT分别为（0.6±0.4）和（1.3±0.6）cm，两组训练前后比较，差异有统计学意义（F＝137.56，P＝0.000）；两组训练前HmaxD比较，差异无统计学意义（P＞0.05）；两组训练后HmaxD比较，差异有统计学意义（F＝4.92，P＝0.033）。结论表面肌电生物反馈疗法联合常规吞咽训练治疗卒中后吞咽功能障碍具有协同疗效。%Objective To observe the effect of surface electromyographic biofeedback on the pharyngeal phase activities in patients with dysphagia after stroke. Methods Seventy-six consecutive patients with pharyngeal dysphagia after stroke admitted to the departments of rehabilitation and neurology,brain hospital affiliated to nanjing medical university from August 2014 to February 2015 were enrolled retrospectively. After excluding 40 patients,the remaining 36 patients were divided into either a conventional training group (n =19)or a biofeedback group (n =17)by using the random number table. The patients of the conventional training group received swallowing function training only,while those of the biofeedback group also received the surface electromyographic biofeedback treatment on the basis of the therapy program of the conventional training group. The patients of both groups were treated 6 times a week for 4 weeks. The assessment of swallowing angiography,the digital measurement and analysis were performed before and after treatment. The outcome measures included the degree of openness of upper esophageal sphincter (UES),0pharyngeal transit time (PTT),and the maximum displacement of the hyoid bone (HmaxD). Results (1)The proportions of UES complete opening of the conventional training group before and after training were 26. 3% (5 / 19)and 47. 4% (9 / 19)respectively. There was significant difference between before and after training (χ2 = 5. 08, P =0.020). The proportions of UES complete opening of the biofeedback group before and after training were 47.1% (8/ 17)and 82.4% (14/ 17)respectively. There was significant difference between before training and after training (χ2 =11.46,P = 0. 001). There was no significant difference in the degrees of UES complete opening before training between the conventional training group and the biofeedback group (P >0. 05). There was significant difference in the degree of UES complete opening after training between the 2 groups (χ2 =4. 63,P = 0. 040). (2)PTT of the conventional training group before and after training was 0.24 ±0.07 and 0.19 ±0.06 s respectively. PTT of the biofeedback before and after training was 0.23 ±0.06 and 0. 15 ± 0. 05 s. There was significant difference between before training and after training (F = 154. 50,P = 0. 000). There was no significant difference in PTT before training between the conventional training group and the biofeedback group (P > 0. 05). There was significant difference in PTT after training between the 2 groups (F =4.66,P = 0. 038). (3)The HmaxD distances of the conventional training group before and after training were 0. 5 ± 0. 4 and 0. 9 ± 0. 4 cm respectively,the PTT of the biofeedback training before and after training was 0. 6 ± 0. 4 and 1. 3 ± 0. 6 cm respectively. There was significant difference between before training and after training (F = 137. 56,P = 0. 000). There was no significant difference in the HmaxD distance of the conventional training group and the biofeedback training group before training (P > 0. 05). There was significant difference in the HmaxD distance after training between the 2 groups (F = 4. 29,P = 0. 033). Conclusion The surface electromyographic biofeedback therapy in combination with the conventional swallowing training for the treatment of dysphagia after stroke has the synergistic efficacy.