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

摘要

目的:应用表面肌电图(surface EMG,sEMG)技术与分析系统,探讨正常受试者和脑卒中后吞咽障碍患者(poststroke dysphagia,PSD)咽期吞咽过程中颏下肌群和舌骨下肌群肌电活动的平均振幅和持续时间的差异.方法:本实验收集正常对照组(健康成人,30例),病例组(PSD确诊患者,30例),对患者临床资料进行收集.采用芬兰Megawin6000-T8型表面肌电图仪采集两组受试者在静息状态、空吞咽、吞咽5ml水时两组肌群的表面肌电信号,分析出平均振幅(average etectromyogram,AEMG)和持续时间两个指标,比较两组之间有无显著性差异.结果:①静息状态下:病例组和对照组颏下肌群和舌骨下肌群的平均振幅均无显著性差异(P＞0.05);病例组:颏下肌群和舌骨下肌群肌电活动的平均振幅相比无显著性差异(P＞0.05);对照组:颏下肌群和舌骨下肌群肌电活动的平均振幅也无显著性差异(P＞0.05).②空吞咽状态下:颏下肌群的平均振幅和持续时间比较,病例组较对照组平均振幅升高,持续时间延长,且具有显著性差异(P＜0.05);舌骨下肌群的平均振幅和持续时间比较,病例组较对照组平均振幅明显升高,持续时间明显延长,且具有显著性差异(P＜0.05);③吞咽5ml水状态下:病例组两组肌群肌电活动的平均振幅较对照组平均振幅显著升高(P＜0.005);病例组两组肌群肌电活动的持续时间较对照组持续时间显著延长(P＜0.001);④组内之间比较:对照组:颏下肌群和舌骨下肌群平均振幅和持续时间在空吞咽和吞咽5ml水状态下均无显著性差异(P＞0.05);病例组:颏下肌群和舌骨下肌群平均振幅和持续时间在空吞咽和吞咽5ml水状态下均无显著性差异(P＞0.05).结论:sEMG技术可以作为一种无创、简单、快速检测咽期吞咽过程中相关肌群肌电活动的方法,通过颏下肌群和舌骨下肌群肌电活动的平均振幅和持续时间可以初步筛查和评估吞咽功能,反映舌骨上抬和喉上抬的难易程度和持续时间,评估患者完成此动作的神经肌肉的功能状态,预测吞咽障碍患者误吸的风险.%Objective:To investigate the difference of amplitude and duration in submental muscles and infrahyoid muscles activities during pharyngeal swallowing between normal adults and post-stroke dysphagia by using surface electromyography technique and analysis system.Method:The clinical data from 30 cases of PSD and 30 healthy controls were collected.ME6000-T8-type sEMG machine was used to collect sEMG of two groups in resting state,saliva swallow and wet swallow,and therefore calculate the average amplitude and duration.Result:①In resting state:there were no statistical difference in the average amplitude of submental and infrahyoid muscles between PSD group and control group(P＞0.05);In PSD group:statistical differences were not observed in the amplitude between submental muscles and infrahyoid muscles;In control group:there were no statistical difference in the average amplitude between submental muscles and infrahyoid muscles;②During dry swallowing:the results indicated that the average amplitude of submental and infrahyoid muscles in PSD group were significantly lower than that in control group;and the duration of submental and infrahyoid muscles was significantly lower with statistical difference(P＜0.05).③During wet swallowing(swallowing"5ml" water):the average amplitude of submental and infrahyoid muscles in control group were significantly higher than that in PSD group(P＜0.005);and the duration of submental and infrahyoid muscles were also significantly prolonger (P＜0.001);④Intra-group comparison:statistically differences were not observed in the amplitude and duration between submental muscles and infrahyoid muscles for both PSD group and control group(P＞0.05).Conclusion:sEMG could be used as a non-invasive、simple、rapid tool in detecting the sEMG activities of related muscles during pharyngeal swallowing.The average amplitude and duration of submental and infrahyoid muscles can not only preliminarily screen and evaluate swallowing function,but also reflect the complexity and the elevation persistence time of the hyoid bone and the larynx in elevation movement,which were used to evaluate the neuromuscular function and predict the risk of aspiration of patients.