神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果

doi:10.3969/j.issn.1006-9771.2017.02.015

《中国康复理论与实践》 ›› 2017, Vol. 23 ›› Issue (2): 194-198.doi: 10.3969/j.issn.1006-9771.2017.02.015

神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果

徐晓明¹, 段隽丹¹, 杨麟²

1.云南省中医医院针灸科,云南昆明市650021;
2.昆明医科大学,云南昆明市 650031

收稿日期:2016-07-28 修回日期:2016-09-19 出版日期:2017-02-05 发布日期:2017-03-06
作者简介:徐晓明(1984-),男,汉族,湖北赤壁市人,在职硕士研究生,康复治疗师,主要研究方向：神经康复治疗、吞咽障碍、失语症的评定与康复治疗。E-mail: 13708861949@163.com。

Effect of Neuromuscular Electrical Stimulation and Sour Taste Therapy on Dysphagia in Oral Phase in Acute Stroke Patients

XU Xiao-ming¹, DUAN Jun-dan¹, YANG Lin²

1. Department of Acupuncture and Moxibustion, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan 650021, China;
2. Kunming Medical University, Kunming, Yunnan 650031, China

Received:2016-07-28 Revised:2016-09-19 Published:2017-02-05 Online:2017-03-06
Contact: XU Xiao-ming. E-mail: 13708861949@163.com

摘要/Abstract

摘要： 目的观察急性/亚急性脑卒中吞咽障碍口腔期患者经神经肌肉电刺激(NMES)、酸性刺激治疗前后功能性经口摄食量表(FOIS)变化及不良反应发生情况。方法 2013年1月至2015年6月,本科90例急性/亚急性脑卒中吞咽障碍口腔期患者随机分为NMES组(n=30)、酸性刺激组(n=30)和综合组(n=30)。各组在常规吞咽功能训练基础上分别应用NMES疗法、酸性刺激疗法、NMES结合酸性刺激疗法。分别于治疗3周、12周采用口腔功能评分方法,观察患者FOIS变化情况。结果治疗3周后,综合组FOIS变化明显优于酸性刺激组(P<0.01);治疗12周后,综合组FOIS变化均优于电刺激组和酸性刺激组(P<0.05)。研究期间无任何治疗相关不良事件发生。结论急性或亚急性脑卒中吞咽障碍口腔期的患者,早期应用NMES结合酸性刺激治疗,有利于提高患者口腔控制食物能力、协调吞咽动作,防止并发症发生。

关键词: 脑卒中, 吞咽障碍, 口腔期, 神经肌肉电刺激, 酸性刺激

Abstract: Objective To explore the effect of early neuromuscular electrical stimulation (NMES) combined with sour taste therapy on dysphagia in the oral phase of acute/subacute ischemic stroke patients. Methods From January, 2013 to June, 2015, 90 patients with oral phase dysphagia after stroke were randomly assigned into NMES group (NM group), sour taste group (ST group ) and NMES combined with sour taste group (TO group) with 30 patients in each group. The swallowing function was evaluated with Functional Oral Intake Scale (FOIS) at baseline, three weeks and twelve weeks treatment. Results The change of FOIS was better in TO group than in ST group three weeks after treatment (P<0.01), and was better in TO group than in ST group and NM group twelve weeks after treatment (P<0.05). Conclusion An early application of NMES combined with sour taste therapy could improve the swallowing coordination, and reduce the the potential complications in oral phase of acute/subacute ischemic stroke patients with dysphagia.

Key words: stroke, dysphagia, oral phase, neuromuscular electrical stimulation, sour taste

中图分类号:

R743.3

徐晓明, 段隽丹, 杨麟. 神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果[J]. 《中国康复理论与实践》, 2017, 23(2): 194-198.

XU Xiao-ming, DUAN Jun-dan, YANG Lin. Effect of Neuromuscular Electrical Stimulation and Sour Taste Therapy on Dysphagia in Oral Phase in Acute Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(2): 194-198.

参考文献

[1] Daniels SK, Brailey K, Priestly DH, et al. Aspiration in patients with acute stroke [J]. Arch Phys Med Rehabil, 1998, 79(1): 14-19.
[2] Roth EJ, Lovell L, Harvey RL, et al. Incidence of and risk factors for medical complications during stroke rehabilitation [J]. Stroke, 2001, 32(32): 523-529.
[3] Logemann JA. Update on Clinical Trials in Dysphagia [J]. Dysphagia, 2006, 21(2): 116-120.
[4] Ludlow CL. Electrical neuromuscular stimulation in dysphagia: current status [J]. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(3): 159-164.
[5] Suntrup S, Marian T, Schröder JB, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial [J]. Intensive Care Medicine, 2015, 41(9): 1-9.
[6] Gatto AR, Cola PC, Silva RG, et al. Sour taste and cold temperature in the oral phase of swallowing in patients after stroke [J]. Codas, 2013, 25(2): 164-168.
[7] 中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014 [J]. 中华神经科杂志, 2015, 48(4): 246-257.
[8] 窦祖林,兰月,于帆,等. 吞咽造影数字化分析在脑干卒中后吞咽障碍患者疗效评估中的应用 [J].中国康复医学杂志, 2013, 28(9): 799-805.
[9] Kramer P, Shein D, Napolitano J. Rehabilitation of Speech, Language and Swallowing Disorders [M]. New York: Springer New York, 2007.
[10] Heijnen BJ, Speyer R, Baijens LWJ, et al. Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia: effects on quality of life [J]. Dysphagia, 2012, 27(3): 336-345.
[11] Costa MM, Almeida JT, Sant'Anna E, et al. Viscosities reproductive patterns for use in videofluoroscopy and rehabilitation therapy of dysphagic patients [J]. Arq Gastroenterol, 2007, 44(4): 297-303.
[12] Holahan JL. Process for Preparing Concentrate Thickener Compositions [Z]. U.S., 2009.
[13] Kushner DS, Peters K, Eroglu ST, et al. Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation [J]. Am J Phys Med Rehabil, 2013, 92(6): 486-495.
[14] Leow LP, Huckabee ML, Sharma S, et al. The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction [J]. Chemical Senses, 2007, 32(2): 119-128.
[15] Miura Y, Morita Y, Koizumi H, et al. Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography [J]. Chem Senses, 2009, 34(4): 325-331.
[16] Soon KS, Lee MY, Tsai WW, et al. Development of a swallowing electrical stimulation system for treatment of dysphagia in stroke patients [J]. J Med Biol Engineer, 2013, 33(5): 497-503.
[17] Teasell RW, Mcrae M, Marchuk Y, et al. Pneumonia associated with aspiration following stroke [J]. Arch Phys Med Rehabil, 1996, 77(7): 707-709.
[18] Smithard DG, O'Neill PA, Martin DF, et al. Aspiration following stroke: is it related to the side of the stroke? [J]. Clin Rehabil, 1997, 11(1): 73-76.
[19] Osawa A, Maeshima S, Matsuda H, et al. Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography [J]. Neuroradiology, 2013, 55(4): 413-421.
[20] Odderson IR, Keaton JC, Mckenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective [J]. Arch Phys Med Rehabil, 1996, 76(12): 1130-1133.
[21] Kajii Y, Shingai T, Kitagawa JI, et al. Sour taste stimulation facilitates reflex swallowing from the pharynx and larynx in the rat [J]. Physiol Behav, 2002, 77(2-3): 321-325.

神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果

Effect of Neuromuscular Electrical Stimulation and Sour Taste Therapy on Dysphagia in Oral Phase in Acute Stroke Patients

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