表面肌电生物反馈疗法结合吞咽训练治疗鼻咽癌放疗后食道上括约肌狭窄的疗效分析

关键词：表面肌电生物反馈疗法  吞咽困难  鼻咽癌  放射治疗  食道上括约肌

Keywords:surface electromyographic biofeedback  dysphagia  nasopharyngeal carcinoma  radiation therapy  upper esophageal sphincter

摘要：

      摘要 目的：观察表面肌电生物反馈疗法（sEMG-BFB）结合吞咽训练对鼻咽癌放疗后食道上括约肌（UES）狭窄的疗效。 方法：选取鼻咽癌放疗后UES狭窄的吞咽障碍患者60例，其中UES不全开放者30例，完全不开放者30例，用随机数字表法将其分为生物反馈组（不全开放者15例，完全不开放者15例）和球囊扩张组（不全开放者15例，完全不开放者15例）。两组均给予口颜面功能训练、口咽感觉训练及进食指导等常规吞咽康复治疗。同时，生物反馈组在sEMG-BFB下进行吞咽行为训练，球囊扩张组予以导尿管球囊扩张术。治疗前、治疗4周后，采用视频吞咽造影观察患者UES的开放情况，采用渗透-误吸评分（PAS）及功能性经口摄食量表（FOIS）对吞咽功能进行评估。 结果：治疗前2组患者UES开放程度、PAS评分、FOIS评分之间比较，差异均无显著性意义（P>0.05）。治疗后效果对比：①UES开放程度比较，两组治疗前后比较，差异均有显著性意义（P<0.05）。对于UES不全开放者，生物反馈组与球囊扩张组疗效对比无明显差异（χ2=0.682，P=0.682）。而在UES完全不开放者中，球囊扩张组疗效要优于生物反馈组（χ2=15.00，P=0.000）。②PAS评分比较，两组患者治疗前后PAS评分，生物反馈组：3.5（3，4）分和3（2，3）分，球囊扩张组：3.5（3，4）分和2（2，2）分，前后差异均有显著性意义（Z值分别为-2.293，-4.014，均P<0.05）。治疗后生物反馈组评分显著高于球囊扩张组（Z=-2.302，P=0.021）。③FOIS评分比较，两组患者治疗前后FOIS评分，生物反馈组：4（3，4）分和5（4，5）分，球囊扩张组：3（3，4）分和5（4，5）分，前后差异均有显著性意义（Z值分别为-2.530，-3.029，均P<0.05），治疗后生物反馈组与球囊扩张组评分无明显差异（Z=-0.143，P=0.886）。 结论：对于UES不全开放的患者，表面肌电生物反馈疗法治疗效果确切，其与球囊扩张术对比疗效无明显差异，但其更安全，副反应更少，值得临床推广。

Abstract:

      Abstract Objective: To investigate the effect of sEMG-BFB combined with routine swallow training in the treatment of dysphagic patients caused by cricopharyngeal stenosis after radiotherapy for nasopharyngeal carcinoma. Method: Sixty dysphagic patients caused by upper UES stenosis after radiotherapy for nasopharyngeal carcinoma were recruited. They were randomly divided into observation group and control group, including 15 patients with incomplete opening of UES sphincter and 15 patients with failure of UES relaxation in each group. Both of them were given routine training including orofacial function training, sensory irritation, and dieting mode proposal, while the observation group was given behavioral swallowing training conducted by the guidance of sEMG-BFB and the control group were treated with active balloon dilataion therapy respectively. Before and after 4 weeks treatment, videofluoroscopy swallowing study（VFSS） was performed to observe the opening of UES. PAS and FOIS were used to evaluate swallow function. Result: Before treatment, there were no significant difference between the two groups in terms of UES opening, PAS score and the FOIS score (P>0.05). ①Comparison of the rate of the UES opening: the UES opening of both group were improved after treatment (P<0.05). There were no significant difference between the two groups in patients with the incomplete opening of UES, while the control group was superior to the treatment group in patients with failure of UES relaxation. ②Comparison of the PAS scores: compared with before treatment, there was significant difference in the PAS score after treatment in each group [3.5(3,4)vs.3(2,3), 3.5(3,4) vs.2(2,2)], (Z=-2.293,-4.014 respectively, all P<0.05). The PAS score of observation groups was significantly higher than that of control group（Z=-2.302，P=0.021）. ③Comparison of the FOIS score: compared with treatment before, there was significant difference in the FOIS score after treatment in each group [4(3,4)vs.5(4,5)，3(3,4) vs. 5(4,5)] (Z=-2.530,-3.029 respectively, all P<0.05). There was no significant difference in FOIS score between the two groups after treatment (4.63±1.56 vs 4.73±1.48)，（Z=-0.143，P>0.886）. Conclusion: The dysphagic patients with incomplete opening of UES after radiotherapy for nasopharyngeal carcinoma could be treated effectively by the way of sEMG-BFB. There is no difference of curative effect between the treatment of sEMG-BFB group and active balloon dilataion therapy group.