喉肌电图评估肌萎缩侧索硬化症患者吞咽功能的初步研究

A Preliminary Study of Laryngeal Electromyography for Evaluating Swallowing Function of Patients with Amyotrophic Lateral Sclerosis

谢华顺;马芙蓉;樊东升;王丽平;闫燕;鹿培泉;

1:北京大学第三医院耳鼻咽喉头颈外科

2:北京大学第三医院神经内科

摘要
目的探讨环甲肌肌电图用于评估肌萎缩侧索硬化症患者吞咽障碍的可行性。方法对25例伴或不伴吞咽异常的肌萎缩侧索硬化症患者行右侧环甲肌肌电图检查,并通过洼田饮水实验对吞咽功能进行评估,比较两种检查结果。结果 25例中,11例环甲肌肌电图表现为典型的失神经支配,15例洼田饮水实验阳性,两种方法符合率为60%(15/25),其中阳性符合率为32%(8/25)。McNemar检验验证喉肌电图检查和洼田饮水试验的一致性,Kappa系数为0.219(P=0.344)。结论环甲肌肌电图可用于评估肌萎缩侧索硬化症患者的吞咽功能,但存在一定的局限性。
关键词
肌萎缩侧索硬化症;喉肌电图;吞咽障碍;洼田饮水试验
基金项目(Foundation):
作者
谢华顺;马芙蓉;樊东升;王丽平;闫燕;鹿培泉;
参考文献

1 D'Ottaviano FG,Linhares Filho TA,Andrade HM,et al.Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis[J].Braz J Otorhinolaryngol,2013,79:349.

2 Leder SB,Novella S,Patwa H.Use of fiberoptic endoscopic evaluation of swallowing(FEES)in patients with amyotrophic lateral sclerosis[J].Dysphagia,2004,19:177.

3 Brooks BR,Miller RG,Swash M,et al.El Esoofial revisited:revised criteria for the diagnosis of amyotrophic lateral sclerosis[J].Amyotroph Lateral Scler Other Motor Neuron Disord,2000,1:293.

4 Cedarbaum JM,Stambler N,Malta E,et al.The ALSFRSR:a revised ALS functional rating scale that incorporates assessments of respiratory function.BDNF ALS Study Group(Phase III)[J].J Neurol Sci,1999,169:13.

5 侯丽珍,韩德民,徐文,等.正常喉肌电生理特点研究[J].听力学及言语疾病杂志,2005,13:152.

6 大西幸子,孙启良.摄食-吞咽障碍康复实用技术[M].北京:中国医药科技出版社,2000.43~44.

7 Garvey CM,Boylan KB,Salassa JR,et al.Total laryngectomy in patients with advanced bulbar symptoms of amyotrophic lateral sclerosis[J].Amyotroph Lateral Scler,2009,10:470.

8 Hillel AD,Robinson LR,Waugh P.Laryngeal electromyography for the diagnosis and management of swallowing disorders[J].Otolaryngol Head Neck Surg,1997,116:344.

9 Fattori B,Grosso M,Bongioanni P,et al.Assessment of swallowing by oropharyngoesophageal scintigraphy in patients with amyotrophic lateral sclerosis[J].Dysphagia,2006,21:280.

10 Ertekin C,Aydogdu I,Yceyar N,et al.Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis[J].Brain,2000,123:125.

11 Amin MR,Harris D,Cassel SG,et al.Sensory testing in the assessment of laryngeal sensation in patients with amyotrophic lateral sclerosis[J].Ann Otol Rhinol Laryngol,2006,115:528.

12 Kidney D,Alexander M,Corr B,et al.Oropharyngeal dysphagia in amyotrophic lateral sclerosis:neurological and dysphagia specific rating scales[J].Amyotroph Lateral Scler Other Motor Neuron Disord,2004,5:150.