神经肌肉电刺激结合吞咽康复训练对脑卒中患者吞咽功能的影响

目的观察神经肌肉电刺激结合吞咽康复训练对脑卒中患者吞咽障碍的治疗效果。方法采用随机数字表将60例患者分为观察组和对照组各30例。对照组接受为期4周吞咽康复训练,观察组在对照组基础上行吞咽神经肌肉电刺激治疗。入院3d内及康复治疗4周后采用Gugging吞咽功能评估量表判定患者吞咽障碍状况,康复训练4周后判定患者吸入性肺炎发生率。结果康复治疗4周后吞咽障碍治疗总有效率观察组93.33%、对照组73.33%,比较差异有统计学意义(P0.05);吸入性肺炎发生率观察组10.00%、对照组33.33%,比较差异有统计学意义(P0.05)。结论神经肌肉电刺激疗法可以提高脑卒中吞咽障碍患者康复治疗效果。     

神经肌肉电刺激配合吞咽功能训练治疗脑卒中后吞咽障碍的疗效观察

目的：观察神经肌肉电刺激配合吞咽功能训练对脑卒中后吞咽障碍患者的治疗效果。方法：将脑卒中后吞咽障碍患者60例随机分为对照组和观察组各30例;2组均接受脑卒中后常规治疗及吞咽训练,观察组加用神经肌肉电刺激;治疗前后采用洼田饮水试验、吞咽障碍程度分级进行评定。结果：治疗15d后,2组洼田饮水试验分级均较治疗前明显下降,且观察组更低于对照组（均P〈0．05）;2组吞咽障碍程度分级均较治疗前明显提高,且观察组更高于对照组（均P〈0．05）。结论：神经肌肉电刺激配合吞咽功能训练能有效改善治疗脑卒中后吞咽障碍。     

Vitalstim神经肌肉电刺激对神经源性吞咽障碍的疗效观察

目的观察Vitalstim神经肌肉电刺激治疗神经源性吞咽功能障碍的疗效。方法 82例神经源性吞咽功能障碍患者分为3组:A组采用吞咽行为治疗,B组采用Vitalstim神经肌肉电刺激治疗,C组在吞咽行为治疗的基础上加用Vitalstim神经肌肉电刺激方法。10次为1个疗程。结果 1~2个疗程后,A组总有效率72.7%,B组总有效率82.6%,C组总有效率94.5%。且C组经吞咽X线电视透视检查(VFSS)评分吞咽障碍恢复分值显著高于A组和B组(P=0.000)。结论在吞咽行为治疗的基础上加用Vitalstim神经肌肉电刺激治疗能更好地改善神经源性吞咽障碍患者尤其是假性球麻痹患者的吞咽功能。     

综合康复对卒中后吞咽障碍及卒中后肺炎的影响

目的观察针刺、神经肌肉电刺激、吞咽训练对脑卒中后吞咽障碍的疗效及对卒中后肺炎发生率的影响。方法伴有吞咽障碍的脑卒中患者分为：训练组(n=188),接受普通吞咽训练;电刺激组(n=196),接受神经肌肉电刺激及吞咽训练;综合组(n=112),接受中医针刺、神经肌肉电刺激及吞咽训练。比较治疗前及治疗后3 周吞咽评分、肺炎发生率及国立卫生研究院卒中量表(NIHSS)评分的改善值,随访出院后3 个月内新发肺炎发生率。结果治疗后,综合组吞咽障碍治疗有效率高于训练组(P<0.01)及电刺激组(P<0.05),治疗期间肺炎发生率低于训练组(P<0.01)及电刺激组(P<0.05),出院后3 个月新发肺炎的发生率3 组间无显著性差异(P>0.05);综合组NIHSS 评分改善值高于训练组(P<0.01)及电刺激组(P<0.05)。结论针刺、神经肌肉电刺激及吞咽训练联合治疗能明显改善脑卒中患者的吞咽功能,减少急性期肺炎发生率。     

神经肌肉电刺激合吞咽肌群训练治疗脑性瘫痪患儿吞咽障碍

目的：探讨神经肌肉电刺激联合吞咽肌群训练对脑性瘫痪患儿吞咽障碍的影响。方法：按随机数字表法将2019年3月~2020年12月治疗的76例脑性瘫痪合并吞咽障碍患儿分为对照组和观察组,每组38例。对照组给予吞咽肌群训练,在此基础上观察组接受神经肌肉电刺激干预。干预前及干预2个月后测定两组吞咽功能,评价干预效果,并记录干预期间不良反应情况。结果：两组干预前吞咽功能比较,差异无统计学意义（P＞0.05）;干预后观察组吞咽功能优于对照组,干预总有效率较对照组高,差异有统计学意义（P＜0.05）。两组干预期间均未发生喉痉挛、血压波动、心动过缓等不良反应。结论：脑性瘫痪合并吞咽障碍患儿接受神经肌肉电刺激联合吞咽肌群训练可有效减轻吞咽障碍,有助于改善吞咽功能,且安全性较好。     

神经肌肉电刺激和吞咽训练对脑卒中后吞咽障碍的影响

目的探讨神经肌肉电刺激疗法与吞咽功能训练治疗脑卒中后吞咽障碍的临床疗效。方法将60例急性脑卒中吞咽障碍患者随机分为电刺激组(n=20)、吞咽训练组(n=20)和联合治疗组(n=20)。3组均在接受常规药物治疗基础上分别加用神经肌肉电刺激、吞咽功能训练或者两者的联合治疗。治疗前和治疗后2周进行洼田饮水试验和吞咽X线电视透视检查(VFSS)。结果 治疗后2周3组洼田饮水试验和VFSS评分均高于治疗前(P<0.05),联合治疗组疗效更明显(P<0.01)。结论神经肌肉电刺激和吞咽功能训练均能明显改善脑卒中后吞咽障碍患者的吞咽功能,联合治疗效果更佳。     

神经肌肉电刺激治疗卒中后神经性吞咽障碍的效果

目的：探讨神经肌肉电刺激联合摄食训练对脑卒中后神经性吞咽障碍患者吞咽功能、神经功能及生活质量的影响。方法：选取2018年6月~2019年12月收治的119例脑卒中后神经性吞咽障碍患者为研究对象,随机分为对照组59例和观察组60例。对照组在常规训练基础上增加摄食训练,观察组在对照组基础上联合神经肌肉电刺激,1个月后观察两组患者吞咽功能、神经功能、生活质量。结果：治疗后两组标准吞咽功能评价量表评分均降低,透视吞咽功能检查评分均升高,舌骨向前、向上移动距离均上升,且观察组变化幅度高于对照组（P＜0.05）;两组治疗后神经功能缺损程度评分降低,且观察组低于对照组（P＜0.05）;两组治疗后生活质量评分均上升,且观察组明显高于对照组（P＜0.05）。结论：神经肌肉电刺激联合摄食训练对脑卒中后神经性吞咽障碍改善效果确切,能够通过反复刺激肌肉神经促使吞咽的作用机制,显著改善患者吞咽及神经功能,提高生活质量。     

神经肌肉促进技术配合吞咽进食训练实时电刺激对脑卒中后早期吞咽障碍的疗效

目的观察神经肌肉促进技术配合吞咽进食训练实时电刺激对脑卒中后患者吞咽障碍的临床疗效。方法 50例急性期脑卒中伴吞咽障碍患者,分为治疗组和对照组各25例。治疗组给予神经肌肉促进技术和VOCASTIM治疗仪治疗,对照组给予常规口腔训练和低频脉冲电刺激。治疗前后采用吞咽障碍程度分级和饮水试验进行评估。结果治疗组和对照组的吞咽障碍程度和饮水试验在治疗后2周和4周均有显著性差异(P<0.05),治疗组的疗效优于对照组(P<0.05)。结论神经肌肉促进技术配合吞咽进食训练实时电刺激有助于促进脑卒中后吞咽障碍患者的功能恢复。     

神经肌肉电刺激治疗脑卒中后吞咽障碍临床疗效的Meta分析

目的 评价神经肌肉电刺激治疗脑卒中后吞咽障碍的疗效,为临床治疗和进一步研究提供参考依据。 方法 计算机检索Cochrane library、Pubmed、Embase、CINAHL、Pro Quest、Psyc ARTICLES、中国知网数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库中有关神经肌肉电刺激治疗脑卒中后吞咽障碍临床疗效的随机对照试验文献,同时筛检纳入文献的参考文献,检索时限为建库至2017年7月30日。由2名研究员按照纳入和排除标准筛选文献、评价质量、提取资料和合并数据,采用RevMan 5.3版软件对文献进行Meta分析。 结果 共纳入11篇随机对照试验文献,共计576例患者。Meta分析结果表明,在有效性上,神经肌肉电刺激联合吞咽训练的疗效优于单纯的吞咽训练,差异具有统计学意义(P<0.01),但并不能缩短咽传递时间(P>0.05);在安全性上,神经肌肉电刺激联合吞咽训练可降低发生误吸的风险,差异具有统计学意义(P<0.01);且神经肌肉电刺激联合吞咽训练可改善生活质量（P<0.01）。 结论 神经肌肉电刺激联合吞咽训练可改善脑卒中后吞咽障碍患者的吞咽功能和生活质量,并降低发生误吸的风险,且目前尚无证据表明神经肌肉电刺激联合吞咽训练可缩短咽传递时间。     

表面肌电图在脑卒中后吞咽障碍中的应用现状

吞咽障碍是临床上常见的并发症,可由多种疾病引起,如中枢神经系统疾病,颅神经病变,神经-肌肉接头疾病等,其中脑卒中是引起吞咽障碍的常见的疾病之一。表面肌电图（sEMG）作为一种简单、无放射性、无创性的方法,可用来监测吞咽过程中的肌肉活动模式,有利于吞咽障碍患者的筛查及早期诊断。本文就表面肌电图在脑卒中后吞咽障碍中的应用现状进行综述,旨在更好地指导sEMG在康复领域中的应用。     

改善吞咽动作的训练方法治疗脑卒中吞咽障碍

目的探讨改善吞咽动作训练治疗脑卒中吞咽障碍疗效。方法对19例脑卒中伴有吞咽障碍患者进行改进的方法训练,用才藤7级分类法判定疗效。结果全部患者总有效率89.5％。结论改善吞咽动作训练方法能有效地提高脑卒中吞咽障碍的疗效。     

心脏术后患者发生获得性吞咽障碍危险因素的Meta分析

目的 通过Meta分析明确心脏术后患者发生获得性吞咽障碍的危险因素。方法 检索中英文数据库及纳入文献的参考文献,由2名评价人员按照标准独立筛选文献、提取资料、评价文献质量。采用RevMan 5.3软件对资料进行Meta分析。结果 共纳入12篇文献,样本量为6 527例。经Meta分析结果显示,年龄、慢性肺部疾病、慢性肾脏疾病、脑血管疾病、充血性心力衰竭、美国纽约心脏病协会心功能分级、围手术期卒中、体外循环时间、主动脉阻断时间、气管插管时间、留置胃管时间具有综合效应,为心脏术后患者发生获得性吞咽障碍的独立预测因素。结论 目前有关心脏术后患者发生获得吞咽障碍危险因素的研究证据尚不足,且由于各研究间吞咽障碍的评估方法差异较大,今后仍需开展控制混杂因素的前瞻性研究进一步明确心脏术后患者发生获得性吞咽障碍的危险因素。     

Swallowing disorders in persons with cerebrovascular accident

Thirty-eight CVA patients with swallowing disorders were studied videofluorographically (VFG) to determine: (1) the nature of their swallowing disorders, (2) the relationship between the site of the cerebrovascular accident and the nature of the swallowing disorder(s) exhibited and (3) the frequency and etiology of any aspiration present. The 38 CVA patients exhibited a variety of physiologic disturbances in swallowing, usually occurring in combination rather than as isolated disorders. A delayed swallowing reflex was the most frequent disorder seen in all patient groups. Reduced pharyngeal peristalsis was the next most frequent disorder, followed by reduced tongue control. Only brainstem CVA patients exhibited reduced laryngeal closure. Two patients (no right CVAs) experienced cricopharyngeal dysfunction. Few differences in nature of swallowing disorders were seen according to lesion location. Approximately one third of the patients aspirated, most frequently because of delayed triggering of the swallowing reflex. All aspiration occurred because of disorders in the pharyngeal stage of the swallow, emphasizing the importance of VFG evaluation of dysphagia in CVA patients.     

吞咽障碍患者饮食管理方案的构建

目的 参照国际吞咽障碍食物标准行动委员会的食品分级标准,基于吞咽功能分级构建吞咽障碍患者饮食管理方案。 方法 2021年1月—3月,系统检索吞咽障碍患者饮食营养管理临床实践指南、手册、专家共识、证据总结和系统评价后进行证据提取整合,经研究小组讨论制订吞咽障碍患者饮食管理方案初稿,采用德尔菲法进行专家函询,针对专家意见,小组讨论后进行修改。 结果 共15名专家完成2轮函询,问卷有效回收率为100%;专家的权威系数为0.880,第2轮专家意见重要性及可操作性肯德尔和谐系数为0.396和0.412。形成的吞咽障碍患者饮食管理方案包括5个一级指标（未通过、4级、3级、2级、1级）,41个二级指标。 结论 专家意见协调程度好,权威性高。形成的吞咽障碍患者饮食管理方案科学可行,可为吞咽障碍患者的饮食管理提供借鉴。     

Evaluation and treatment of swallowing impairments

Swallowing disorders are common, especially in the elderly, and may cause dehydration, weight loss, aspiration pneumonia and airway obstruction. These disorders may affect the oral preparatory, oral propulsive, pharyngeal and/or esophageal phases of swallowing. Impaired swallowing, or dysphagia, may occur because of a wide variety of structural or functional conditions, including stroke, cancer, neurologic disease and gastroesophageal reflux disease. A thorough history and a careful physical examination are important in the diagnosis and treatment of swallowing disorders. The physical examination should include the neck, mouth, oropharynx and larynx, and a neurologic examination should also be performed. Supplemental studies are usually required. A videofluorographic swallowing study is particularly useful for identifying the pathophysiology of a swallowing disorder and for empirically testing therapeutic and compensatory techniques. Manometry and endoscopy may also be necessary. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitative measures, which may include dietary modification and training in specific swallowing techniques. Surgery is rarely indicated. In patients with severe disorders, it may be necessary to bypass the oral cavity and pharynx entirely and provide enteral or parenteral nutrition.     

Neurogenic dysphagia: physiology,physiopathology and rehabilitative treatment

Swallowing is both a voluntary than a reflex function. It consist in transporting feeding from mouth to the stomach. Swallowing function occurs with very frequency during the day and needs complex neuromuscular coordination. Several neurologic diseases determine swallowing disorders. Dysphagia, is the difficulty in swallowing. In slight disorders, swallowing function is sufficiently compensated, symptoms are few or absent. Sometimes the patient is able to compensate and obtains a safe deglutition. Rehabilitation of swallowing disorders is based on the assessment of all symptoms and troubles causing dysphagia and on the improvement of the specific disabilities. Rehabilitation is aimed to make patient able for a safe oral feeding. We can use classic specific physiotherapy, compensatory movements of head and neck, electrostimulation, and the chemical myotomia by botulinum toxin injection.     

Videofluoroscopy study of swallowing in neurogenic dysphagia

Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.     

An Evaluation of Chewing and Swallowing for a Child Diagnosed with Autism

Pediatric feeding disorders comprise a range of developmental and behavioral disorders. To date, chewing and swallowing has not received as much clinical or research focus as other aspects of pediatric feeding disorders (e.g., acceptance, inappropriate mealtime behavior). The current analysis was conducted to increase the consumption of non-preferred target foods in a child diagnosed with autism. An initial chewing assessment was conducted to increase his compliance with chewing the target foods and a subsequent assessment was conducted to increase swallowing. Results are discussed in terms of the use of behavioral interventions to address chewing and swallowing.     

利用录像X线透视技术评价吞咽障碍

利用录像X线透视技术的目的是使正侧位下的吞咽过程可视化,使得吞咽障碍的症状可视化,并评价各种已选用的治疗措施的有效性。通过分析使用录像X线透视技术的评价结果,能够提供（制定）治疗计划的根据。本文将包括如下部分：正常解剖、生理概述,与吞咽相关的组织结构的影像学定位,正常吞咽的生理过程的录像X线透视图像,识别反映吞咽问题的症状和障碍,治疗计划概述。     

Validation of the 50 ml3 drinking test for evaluation of post-stroke dysphagia

Aspiration pneumonias are frequent complications of cerebrovascular accidents (CVA). They occur mainly in patients suffering from swallowing disorders following the CVA. These patients can be diagnosed using a bedside swallowing evaluation. This evaluation is based on observation of some components of the oral and pharyngeal stages of the swallowing process and on a drinking test of 50 ml³ of clear liquids. Changing the mode of swallowing and the consistency of the diet according to the swallowing evaluation following CVA can reduce significantly the frequency of aspiration pneumonias. In our patient cohort, consisting of 180 patients admitted for stroke rehabilitation, aspiration pneumonias occurred in 10% and swallowing disorders were found in 28%. The administration of a structured swallowing evaluation was associated with a gradual reduction of frequency of pneumonia from 16% in the first group of 60 patients to 3% in the last group of 60 patients or, if considering only patients suffering from dysphagia, from 27% in the first group of patients to none in the last group of patients.