上舌骨肌訓練可能可以改善老年患者吞咽困難的症狀

抬頭鍛鍊可能能使依賴鼻餵食患者恢復口腔進食的能力

  2002年6月10日報導─許多老年患者在發生腦中風後、接受手術後,或接受頸部放射治療後,需要利用鼻餵食的方法來治療吞咽困難。Gastroenterology雜誌6月份一期中報導的一項研究的結果顯示,通過抬頭的訓練來加強上舌骨肌的功能,可能能使患者恢復口腔進食的能力。

  美國米爾沃基市威斯康星州醫科大學的Reza Shaker,和他的同事們寫道:「有意識的強化上舌骨肌功能的訓練計劃,對於某些因上食管括約肌(UES)開放異常,所造成的吞咽困難的患者的恢復口腔進食的治療,是非常有效的,吞咽困難的病因和持續的時間長短並不會影響治療的結果。」

  Shaker的小組對27名患者,在為期6週的抬頭訓練前後的吞咽指數,進行螢光鏡可視試驗和功能的評價。其中有7人在被隨機分配接受上舌骨肌強化治療之前,接受虛假的鍛鍊,27人中的11人被隨機分配接受上舌骨肌強化訓練的治療。

  在進行上舌骨肌強化治療的6週後,所有11名患者UES通道的開放功能、前喉移動能力得到了顯著的改善(P<.01),吞咽的決心得到了提高,並且口腔進食的能力得到了恢復。在虛擬的鍛鍊後,吞咽功能和生物學機能沒有變化,但是當這7名患者加入到真正的鍛煉中後,症狀得到了顯著的改善。在整個27名患者中,治療前後,對前後UES的開放功能、前喉的移動、和吞咽功能結果的評價也顯示出明顯的提高。

  作者寫道:「有必要進行更大規模的臨床試驗,透過較長時間的追蹤,來進一步評價在不同的患者中,這種訓練的臨床療效和使用方法。」

Suprahyoid Exercise May Improve Dysphagia in Elderly Patients

Head-Raising Allowed Tube Dependent Patients to Resume Oral Feeding

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 10, 2002 -- Many elderly require a feeding tube for dysphagia following strokes, operations, or neck radiation. A study in the June issue of Gastroenterology suggests that strengthening the suprahyoid muscles with head-raising exercises may allow patients to resume oral feedings.

"The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal upper esophageal sphincter (UES) opening," write Reza Shaker and colleagues from the Medical College of Wisconsin in Milwaukee. "Etiology and duration of dysphagia did not affect the outcome."

Shaker's group studied 27 patients with videofluoroscopy and functional assessment of swallowing scores before and after six weeks of a head-raising exercise program. Seven of these patients were randomized to a sham exercise program before the suprahyoid-strengthening program, and 11 of 27 were randomized to the suprahyoid-strengthening program.

After six weeks of the suprahyoid-strengthening program, all 11 patients improved significantly in UES opening, anterior laryngeal excursion (P<.01), resolution of postdeglutitive aspiration and resumption of oral feeding. There was no change in swallowing function and biomechanics after the sham exercise, but these seven patients improved significantly when they crossed over to the real exercise group. In the entire group of 27 patients, before and after exercise values for anteroposterior UES opening, laryngeal anterior excursion, and functional outcome assessment of swallowing also showed significant improvements.

"A larger clinical trial with a long-term follow-up period is necessary to further evaluate the clinical efficacy and indications of this exercise in various patient groups," the authors write.

© 2002 WebMD Inc. All rights reserved.

    
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