表面肌电图在环咽肌失弛缓患者吞咽障碍评定中的应用

doi:10.3969/j.issn.1006-9771.2020.11.005

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (11): 1275-1279.doi: 10.3969/j.issn.1006-9771.2020.11.005

表面肌电图在环咽肌失弛缓患者吞咽障碍评定中的应用

王慧灵,冯晓东,李瑞青,兰晓燕,赵薇,张铭()

河南中医药大学第一附属医院,河南郑州市 450000

收稿日期:2019-12-23 修回日期:2020-05-28 出版日期:2020-11-25 发布日期:2020-11-24
通讯作者: 张铭 E-mail:zhm7919@sina.com
作者简介:王慧灵(1989-),女,汉族,河南叶县人,硕士,医师,主要研究方向：中西医结合治疗功能障碍的基础及临床研究。|张铭(1979-),男,汉族,河南温县人,硕士,副主任医师,主要研究方向：脑外伤、脑卒中后意识障碍、运动、言语、吞咽功能障碍的中西医结合治疗研究。
基金资助:
河南省中医药科学研究专项课题(2017ZY2093);河南省中医药科学研究专项课题(2016ZY1005);河南省中医药科学研究专项课题(2019ZY2119)

Application of Surface Electromyography in Assessment of Dysphagia after Cricopharyngeal Achalasia

WANG Hui-ling,FENG Xiao-dong,LI Rui-qing,LAN Xiao-yan,ZHAO Wei,ZHANG Ming()

The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 450000, China

Received:2019-12-23 Revised:2020-05-28 Published:2020-11-25 Online:2020-11-24
Contact: ZHANG Ming E-mail:zhm7919@sina.com
Supported by:
Henan Chinese Medicine Science Research Project(2017ZY2093);Henan Chinese Medicine Science Research Project(2016ZY1005);Henan Chinese Medicine Science Research Project(2019ZY2119)

摘要/Abstract

摘要：

目的观察舌骨下肌群和颏下肌群表面肌电图(sEMG)在缺血性脑卒中后环咽肌失弛缓患者吞咽评定中的应用价值。方法 2015年1月至2019年12月,本院缺血性脑卒中后咽期吞咽障碍患者48例,根据透视荧光吞咽检查(VFSS)结果,存在环咽肌功能异常者为观察组,无环咽肌功能异常者为对照组,各24例,同期选取健康志愿者24例为健康组。行sEMG检测,记录三组在静息,空吞咽,吞咽水、浓流质、糊状食物等不同模式下,舌骨下和颏下肌群的均方根值(RMS),观察RMS与VFSS的相关性。结果各组各肌群RMS均随吞咽难度提高而显著升高(F > 77.652, P< 0.001)。相同吞咽模式下,观察组各肌群RMS最高,其次为对照组和健康组(F > 42.505, P< 0.001)。各肌群RMS与VFSS评分呈正相关(r > 0.548, P <0.05)。结论检测缺血性脑卒中后环咽肌失弛缓患者咽期颏下及舌骨下肌群sEMG,可初步揭示吞咽肌收缩力,为临床筛查和评估吞咽功能提供帮助。

关键词: 脑卒中, 脑缺血, 吞咽障碍, 环咽肌失弛缓, 表面肌电图

Abstract:

Objective To apply surface electromyography (sEMG) in assessment of swallow function for patients with cricopharyngeal achalasia.Methods From January, 2015 to December, 2019, 48 patients with dysphagia after ischemic stroke accepted videofluoroscopic swallowing study (VFSS); those with cricopharyngeal achalasia were as observation group (n = 24), and those without cricopharyngeal achalasia were as control group (n = 24). Other 24 healthy subjects were as healthy group. They accepted sEMG at infrahyoid muscles and submental muscles as they were resting, and swallowing nothing (saliva), water, thick fluid and semiliquid food. The root mean square (RMS) of sEMG was recorded. The correlation of RMS and VFSS was anlyzed.Results The RMS of both muscle groups increased with the difficuty of swallowing in all the groups (F > 77.652, P< 0.001). For every condition, the RMS of both muscle groups was the most in the observation group, and then for the control group and the healthy group (F > 42.505, P< 0.001). The RMS of both muscle groups positively correlated with VFSS score (r > 0.548, P <0.05).Conclusion sEMG can be used to quantitatively assess the contraction of submental muscles and infrahyoid muscles in cricopharyngeal achalasia patients after ischemic stroke, which may help to evaluate swallowing function.

Key words: stroke, cerebral ischemia, dysphagia, cricopharyngeal achalasia, surface electromyography

中图分类号:

R743.3

王慧灵,冯晓东,李瑞青,兰晓燕,赵薇,张铭. 表面肌电图在环咽肌失弛缓患者吞咽障碍评定中的应用[J]. 《中国康复理论与实践》, 2020, 26(11): 1275-1279.

WANG Hui-ling,FENG Xiao-dong,LI Rui-qing,LAN Xiao-yan,ZHAO Wei,ZHANG Ming. Application of Surface Electromyography in Assessment of Dysphagia after Cricopharyngeal Achalasia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1275-1279.

图/表 4

表1

表2

表3

表4

参考文献 24

[1]	麦艺颖, 戴萌, 谢纯青, 等. 电视透视吞咽检查定量评价脑干梗死患者吞咽障碍特点的临床研究[J]. 中华物理医学与康复杂志, 2018, 40(2):87-90.
	Mai Y Y, Dai M, Xie C Q, et al. Dysphagia after brain stem infarction: a quantitative analysis of videofluoroscopic observations[J]. Chin J Phys Med Rehabil, 2018, 40(2):87-90.
[2]	王利春, 田宝超, 刘杰, 等. 超声联合电刺激定位肉毒毒素注射治疗环咽肌失弛缓性吞咽困难1例[J]. 中国康复理论与实践, 2020, 26(1):102-105.
	Wang L C, Tian B C, Liu J, et al. Ultrasound-and electrical stimulation-guided Botulinum toxin injection for cricopharyngeal achalasia dysphagia: a case report[J]. Chin J Rehabil Theory Pract, 2020, 26(1):102-105.
[3]	Benfield J K, Everton L F, Bath P M, et al. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: a systematic review and meta-analysis[J]. J Clin Nurs, 2020, 29(9-10):1527-1538. doi: 10.1111/jocn.v29.9-10
[4]	李振亚, 汪秀玲. 数字化吞咽造影录像在急性缺血性脑卒中后吞咽障碍患者中的应用[J]. 中国数字医学, 2019, 14(11):65-67.
	Li Z Y, Wang X L. Application of digital videofluoroscopic swallowing study (VFSS) in patients with dysphagia after acute ischemic stroke[J]. Chin Digit Med, 2019, 14(11):65-67.
[5]	庄任, 方罡, 贺颖超, 等. 表面肌电图技术在脑卒中后吞咽障碍评估中的应用[J]. 中国临床研究, 2019, 32(4):493-496.
	Zhuang R, Fang G, He Y C, et al. Surface electromyography in evaluation of dysphagia after stroke[J]. Chin J Clin Res, 2019, 32(4):493-496.
[6]	肖灵君, 薛晶晶, 燕铁斌, 等. 表面肌电图在吞咽功能评估中的信度研究[J]. 中国康复医学杂志, 2014, 29(12):56-59.
	Xiao L J, Xue J J, Yan T B, et al. Chin J Rehabil Med, 2014, 29(12):56-59.
[7]	Constantinescu G, Hodgetts W, Scott D, et al. Electromyography and mechanomyography signals during swallowing in healthy adults and head and neck cancer survivors[J]. Dysphagia, 2017, 32(1):90-103. doi: 10.1007/s00455-016-9742-6 pmid: 27565156
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chin J Neurol, 2018, 51(9):666-682.
[9]	王珧, 田丽, 饶江, 等. 正常中老年人咽期吞咽功能的表面肌电图研究[J]. 中国康复理论与实践, 2016, 22(8):932-935.
	Wang Y, Tian L, Rao J, et al. Surface electromyography studies of pharyngeal swallowing in healthy middle-aged and old people[J]. Chin J Rehabil Theory Pract, 2016, 22(8):932-935.
[10]	高婧慧, 王强, 李明, 等. 神经肌肉电刺激对脑卒中后吞咽障碍患者舌骨喉复合体动度的影响[J]. 中华物理医学与康复杂志, 2015, 37(5):348-352.
	Gao J H, Wang Q, Li M, et al. Effect of neuromuscular electrical stimulation on hyolaryngeal structural movement in post-stroke dysphagia[J]. Chin J Phys Med Rehabil, 2015, 37(5):348-352.
[11]	刘邦亮, 王根发, 朱美兰, 等. 表面肌电图在单侧脑卒中患者30 s反复唾液吞咽试验中的比较研究[J]. 中国康复医学杂志, 2018, 33(7):822-827.
	Liu B L, Wang G F, Zhu M L, et al. A comparative study on 30s repeated swallowing saliva test with surface electromyography in unilateral stroke patients[J]. Chin J Rehabil Med, 2018, 33(7):822-827.
[12]	苏文华, 阎文静, 钟明华, 等. 神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及其表面肌电图的影响[J]. 中华物理医学与康复杂志, 2015, 37(3):183-186.
	Su W H, Yan W J, Zhong M H, et al. The effect of neuromuscular electrical stimulation on swallowing function after stroke[J]. Chin J Phys Med Rehabil, 2015, 37(3):183-186.
[13]	何金华, 张娟, 袁丽平, 等. 表面肌电图在儿童吞咽障碍疾病中的应用[J]. 中国当代儿科杂志, 2019, 21(11):1089-1093.
	He J H, Zhang J, Yuan L P, et al. Application of surface electromyography in children with dysphagia[J]. Chin J Contemporary Pediatr, 2019, 21(11):1089-1093.
[14]	Kothari M, Stubbs P W, Pedersen A R, et al. Reliability of surface electromyography measurements from the suprahyoid muscle complex[J]. J Oral Rehabil, 2017, 44(9):683-690. doi: 10.1111/joor.12537 pmid: 28644567
[15]	姜帆, 卢柳西, 姜中碧, 等. 表面肌电图在脑卒中后肌张力障碍康复的应用进展[J]. 临床合理用药杂志, 2017, 10(20):180-181, 177.
	Jiang F, Lu L X, Jiang Z B, et al. Chin J Clin Ration Drug Use, 2017, 10(20):180-181, 177.
[16]	金佳然, 朱玉连. 表面肌电图在脑卒中康复中的应用与研究进展[J]. 中国康复, 2016, 31(3):197-200.
	Jin J R, Zhu Y L. Chin J Rehabil, 2016, 31(3):197-200.
[17]	Nowakowski M, Trybek P, Machura L. Correlation based analysis of sEMG signals during complex muscle activity. Feasibility study of new methodology[J]. Folia Med Cracov, 2017, 57(2):41-52. pmid: 29121036
[18]	贺涓涓, 卫小梅, 孔庆聪, 等. 鼻咽癌放疗后患者吞咽时颏下肌群和舌骨下肌群表面肌电信号特征分析[J]. 中华物理医学与康复杂志, 2017, 39(12):899-902.
	He J J, Wei X M, Kong Q C, et al. The characteristics of the surface electromyographic signals recorded from submental and infrahyoid muscles when swallowing in patients with nasopharyngeal carcinoma after radiotherapy[J]. Chin J Phys Med Rehabil, 2017, 39(12):899-902.
[19]	刘玲玲, 冯珍. 表面肌电图技术在卒中后咽期吞咽功能障碍评估中的应用研究[J]. 中国康复医学杂志, 2017, 32(5):534-538.
	Liu L L, Feng Z. The application of surface electromygraphy in functional assessment of patients with post-stroke pharyngeal dysphagia[J]. Chin J Rehabil Med, 2017, 32(5):534-538.
[20]	Bartlett R S, Thibeault S L. Insights into oropharyngeal dysphagia from administrative data and clinical registries: a literature review[J]. Am J Speech Lang Pat, 2018, 27(2):868-883.
[21]	谢纯青, 武惠香, 万桂芳, 等. 鼻咽癌放疗术后吞咽障碍患者的吞咽造影影像学研究[J]. 中华物理医学与康复杂志, 2019, 41(3):170-173.
	Xie C Q, Wu H X, Wan G F, et al. Dysphagia after radiotherapy for nasopharyngeal carcinomaas evaluated with videofluoroscopic swallowing study[J]. Chin J Phys Med Rehabil, 2019, 41(3):170-173.
[22]	常红, 赵洁, 张诗涵, 等. 量化食物稠度对减少脑卒中吞咽障碍患者误吸的效果评价[J]. 中华护理杂志, 2018, 53(1):32-35.
	Chang H, Zhao J, Zhang S H, et al. Evaluation of effects of quantification of food thickness on prevention of aspiration in stroke patients with dysphagia[J]. Chin J Nurs, 2018, 53(1):32-35.
[23]	王珧, 刘莉, 饶江, 等. 老年无症状腔隙性脑梗死患者咽期吞咽功能的表面肌电特点[J]. 中国康复理论与实践, 2017, 23(8):924-927.
	Wang Y, Liu L, Rao J, et al. Pharyngeal swallowing function in elderly patients with asymptomatic lacunar infarction:surface electromyography study[J]. Chin J Rehabil Theory Pract, 2017, 23(8):924-927.
[24]	朱菊清, 冯子平. 神经肌肉电刺激联合吞咽训练治疗脑卒中后吞咽障碍的临床效果分析[J]. 中国现代医生, 2014, 52(20):12-14.
	Zhu J Q, Feng Z P. Analysis of the clinical effects of neuromuscular electrical stimulation combined swallowing training to treat dysphagia after stroke[J]. Chin Modern Doctor, 2014, 52(20):12-14.

组别	n	性别(男/女, n)	年龄(岁)	身高(cm)	体质量(kg)
健康组	24	10/14	52.37±6.59	170.54±6.41	62.79±6.05
对照组	24	12/12	53.04±7.38	168.20±6.53	62.41±4.28
观察组	24	7/17	55.58±7.50	167.83±4.46	59.50±5.09
χ²/F值		1.072	1.337	1.618	2.888
P值		0.425	0.269	0.206	0.062

组别	n	皮质和白质	桥脑	延髓	基底节区	多发性	大脑半球
对照组	24	2	8	7	4	2	1
观察组	24	0	2	22	0	0	0

组别	n	静息	空吞咽	吞咽水	吞咽浓流质	吞咽糊状	F值	P值
健康组	24	0.79±0.16	6.76±0.97	10.32±1.68	13.02±1.41	15.50±0.99	77.654	< 0.001
对照组	24	6.27±1.97	16.55±2.89	13.90±2.50	15.13±2.27	17.58±2.56	77.652	< 0.001
观察组	24	6.26±1.58	28.75±4.65	28.72±6.38	30.15±3.48	34.85±3.15	171.803	< 0.001
F值		42.505	284.242	137.124	323.852	462.993
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	n	静息	空吞咽	吞咽水	吞咽浓流质	吞咽糊状	F值	P值
健康组	24	2.19±0.61	5.54±1.46	7.83±2.05	12.04±1.40	15.29±2.30	98.327	< 0.001
对照组	24	6.26±1.49	17.48±2.63	14.25±2.51	16.11±2.28	17.66±2.86	92.311	< 0.001
观察组	24	7.13±2.64	28.52±4.55	25.13±2.42	26.78±4.87	29.91±1.72	176.012	< 0.001
F值		52.091	318.842	160.626	246.709	269.014
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

表面肌电图在环咽肌失弛缓患者吞咽障碍评定中的应用

Application of Surface Electromyography in Assessment of Dysphagia after Cricopharyngeal Achalasia

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 24

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[2]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[3]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[4]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[5]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[6]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[7]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[8]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[9]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[10]	李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.
[11]	崔尧, 丛芳, 黄富表, 曾明, 颜如秀. 不同镜像神经元训练策略下脑与肌肉的活动特征：基于近红外光谱与表面肌电图技术[J]. 《中国康复理论与实践》, 2023, 29(7): 782-790.
[12]	华玲, 张一楠, 郑玉, 孙俏仪, 房辉, 宋达. 手控节律音乐治疗对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 833-838.
[13]	蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.
[14]	许苗苗, 李楠, 应颖, 杨凯翔, 杨婧瑞, 李杰, 邱彦群. 重复外周磁刺激对左右颈7神经交叉移位术后脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 686-690.
[15]	郑莉, 鲍治诚, 张琪, 任绪艳, 苏敏. 经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 691-696.